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THE 



J-Jomceopathic Treatment 



OF 



urgical Diseases, 



BY 



J. G. GILCHRIST, M. D., 

(Editor of the Surgical Department of The Medical Investigator^ 



D 

-1 .;- ■ ; 






CHICAGO: / 

C. S. Halsey, No. 72 State Street. 

New York: Bcericke & Tafel, 145 Grand Street, 

1873. 




Entered according to Act of Congress, in the year 1873, by 

C. S. HALSEY, 
in the office of the Librarian of Congress, at Washington. 







PREFACE. 



At the time this little book was projected, so far as my know- 
ledge extended, there was not one line, outside of our periodical 
literature, that taught the application of our therapeutic principles 
to the treatment of so-called "Surgical Diseases." A work on 
this subject has been sorely needed, and our accumulated expe- 
rience demands a gathering together of this scattered material. 

Having had some years ago a case to treat in which a fibroid 
growth was a prominent symptom, I sought the advice of men 
grown gray in the service. Heretofore there had been no hesit- 
ancy on my part in cutting out such symptoms, supposing them 
to be the disease in esse. 

Dr. Guernsey had opened my eyes a little, hence a desire to 
cure this case, which could not have been done by an operation. 
One of those to whom I applied for aid, said, " Treat your 
patient, never mind the tumor," a maxim but half comprehended 
at the time. Another said, "Cut it out;" I knew more myself. 
A third, "I know nothing about it;" just my condition. Being 
thrown thus upon my own resources, the case was studied, the 
patient cured, and the tumor disappeared. This case led to 
further study and experiment, the results of which are found in 
the following pages. 

The attention of the profession has been directed to this 
study more persistently of late years, but the present work is the 
first attempt at a systematic treatise, I believe. Being, then, a 



I o Preface. 

" pioneer work," so to speak, there must be some imperfections; 
I trust but few inaccuracies. 

It may be objected (and I allow that the objection has weight) 
that works of this character are apt to encourage superficial 
study of the Materia Medica, and, perhaps, tend to perpetuate 
the absurd custom of treating diseases by name rather than 
symptoms. It has been the main object of this work to teach, 
unmistakably, that apart from mechanical injuries (and these 
are not diseases) there can be no such thing as a local disease. 
Tumors, ulcers, and all kinds of abnormal growths, are simply 
symptoms ; peripheral symptoms of a generally diseased organism. 
A man is wounded; the wound made with a non- poisoned, 
clean -cutting instrument. The wound does not heal, as it 
should, but an ulcer is produced. Can this be called a local 
disease? No! because in ninety -nine other identical cases no 
ulcer results. It indicates, as before said, a taint, diathesis, pre- 
disposition, or what you please to call it, latent in the system, 
only waiting for a favorable opportunity to be developed in some 
situation only to be determined by circumstances. 

If this is one object of the work, it may be asked, why not 
give fuller indications for the application of remedies instead of 
confining them to the local symptoms of the disease under dis- 
cussion? The answer is easy, and will dispose of the first 
objection as well. 

The student of homoeopathy finds one difficulty in studying 
the Materia Medica in connection with surgical diseases. Surgi- 
cal diseases may be called those which are chiefly recognized 
through objective symptoms. A new form of tumor is found, 
i.e., new to the student, and where in our bulky Materia Medica 
will he find its simile? It is not there. A remedy has never 
developed a tumor during a proving. Applying remedies for 
symptoms apparently unconnected with this tumor, we have now 
and then succeeded in causing a disappearance of the growth, 
and in time the fact creeps into the symptomatology as a " clinical 



Preface. 1 1 

symptom." Many of these clinical symptoms are only to be 
found in our periodicals, and many more in private case books. 
It has been my task to gather as many of these as possible, and 
thus reduce the number of remedies to be consulted from four 
hundred in number to a very few. When the objective symptoms 
are found in the following pages, the Materia Medica must be 
consulted for those which are subjective, the union of the two 
making the true similar, which is the only agent that will cure. 
It is not enough to know there is a cataract to cure, for instance, 
but we must find a remedy that has a picture of the constitution 
and little mental peculiarities of our patient as well. I hope that 
this work will be found to be a guide to the Materia Medica, and 
in no sense a substitute for it. 

In closing my labors I feel under obligations to return my 
sincere thanks to Drs. T. C. Duncan and H. B. Fellows, of 
Chicago, for the valuable aid they have afforded me in seeing 
the work through the press. Without their aid it would have 
been almost impossible to have carried it to a successful ter- 
mination. Let me ask then, in the language of an "old play," 
" What of merit mav be found give to us three : what of blame 
give to me alone." J. G. G. 

yanuary I, 1873. 



CONTENTS. 



PAGE. 

Preface - - - - - - - -9 

Introductory - - - - - - - -17 

DISEASES OF THE MIND: 19 

Shock ; Traumatic delirium. 

DISEASES OF THE HEAD : - - - - - -22 

Injuries of Scalp ; Wounds of Brain ; Compression of Brain ; Her- 
nia Cerebri ; Concussion of Brain ; Fungus of the Dura-Mater ; 
Irritation of the Brain ; Fungus of the Cranium ; Traumatic 
Encephalitis. 

DISEASES OF THE FACE: 37 

Wounds of the Face ; Salivary Fistula. 

DISEASES OF THE EAR: 39 

Otitis ; Otorrhcea ; Deafness ; Various Diseases. 

DISEASES OF THE EYE: ------ 50 

Foreign bodies in the Eye ; Wounds of the Eye ; Ophthalmia ; Stra- 
bismus ; Pterygium ; Opacity of the cornea ; Chemosis ; CEdema of 
the Lids ; Fistula lachrymalis ; Cataract ; Retinitis ; Iritis ; Malig- 
nant Tumors ; Various Diseases. 

DISEASES OF THE NOSE: 74 

Epistaxis ; Lipoma ; Various Nasal Diseases ; Dropsy of the Antrum ; 
Suppuration of the Antrum. 

DISEASES OF THE MOUTH: '- - - - - 83 

Glossitis ; Prolapsus of the Tongue ; Abscess of the Tongue ; Ranula ; 
Various Diseases of the Tongue ; Abscess and Ulceration of the 
Gums ; Epulis. '' 

DISEASES OF THE THROAT: 97 

Wounds of the Esophagus ; Foreign bodies in Esophagus ; Stricture 
of the Esophagus ; Scalds of mouth and pharynx ; Injuries to the 
air passages ; Foreign bodies in the air passages ; Asphyxia ; Vari- 
ous diseases of Pharynx ; Cancrum oris ; Laryngitis ; Parotitis ; 
Enlarged Tonsils ; Bronchocele. 



1 4 Contents. 



PAGK. 

DISEASES OF THE CHEST AND BREAST : - - 123 

Injuries of the Chest ; Emphysema ; Pneumo - Thorax ; Traumatic 
Pneumonia ; Empyema ; Neuralgia of Breast ; Hypertrophy of the 
Breast ; Inflammation of Breast ; Suppuration of Breast ; Malig- 
nant Tumors of Breast. 

DISEASES OF THE SPINE : 133 

Injuries of the Spine ; Caries ; Lateral curvature ; Spina - bifida ; 
Myelitis. 

DISEASES OF THE ABDOMEN: -. - - - - 148 

Injuries to the Abdomen ; Injuries to Pelvic Viscera. 

DISEASES OF THE INTESTINES: 158 

Hernia ; Intestinal obstructions. 

DISEASES OF THE ANUS AND RECTUM: - - - 169 

Haemorrhoids ; Ulcer and Fissure of Anus ; Fistula in Ano ; Pro- 
lapsus Recti. v 

DISEASES OF THE PENIS : -. 181 

Syphilis ; Phimosis ; Paraphimosis ; Balanitis ; Herpes of the Glans 
and Prepuce ; Warts on the Glans. 

DISEASES OF THE BLADDER AND APPENDAGES : - - 203 

Diseases of the Prostate ; Perineal Abscess ; Urethritis ; Gonorrhoea ; 
Stricture of the Urethra ; Cystitis ; Tumors of the Bladder ; Paral- 
ysis of the Bladder ; Calculi. 

DISEASES OF THE SCROTUM AND TESTICLES. - - 235 

Orchitis ; Hydrocele ; Varicocele ; Hematocele. 

DISEASES OF THE FEMALE GENITALS: - - - 245 

Diseases of the Uterus ; Ovarian Tumors ; Vaginal Fistulae. 

DISEASES OF THE JOINTS: 266 

Synovitis ; Arthritis ; White Swelling ; Anchylosis ; Hip - disease ; 
Enlarged Bursae ; Ganglions ; Wounds of Joints ; Dislocations ; 
Strains. 

DISEASES OF THE BONES: 288 

Periostitis ; Osteitis ; Caries ; Hypertrophy ; Rickets ; Fragilitas 
Ossium ; Tubercles ; Exostosis ; Osteo-sarcoma ; Hydatids ; Osteo- 
aneurism ; Fractures. 

DISEASES OF THE NAILS: 297 

Onychia ; In-growing Toe-nail. 

DISEASES OF THE BLOOD-VESSELS: - - - - 299 

Phlebitis ; Varices ; Pyemia ; Aneurism ; Aneurism by Anastomosis ; 
Arteritis ; Fatty degeneration of Arteries ; Calcification of Arteries ; 
Nevus ; Wounds of Blood-vessels. 



Contents. 1 5 



PAGE. 



DISEASES OF THE NERVES: 320 

Neuralgia ; Neuritis ; Neuroma ; Tetanus ; Wounds of Nerves. 

SUPPURATION: - - 341 

Abscess ; Sinus ; Fistula. 

ULCERS: - 351 

GANGRENOUS DISEASES: - - - - - - 364 

Mortification ; Bed-sores ; Sloughing phagedena ; Carbuncles ; Boils. 

TUMORS 375 

Innocent ; Semi-malignant ; Malignant. 

EFFECTS OF HEAT AND COLD: 402 

Burns ; Scalds ; Frost-bite. 

INDEX 415 



THE 



HOMCEOPATHIC TREATMENT 



OF 



Surgical Diseases. 



INTRODUCTION. 

Among all the books treating on Surgery in our profession, there 
is not one presenting any thing more than the merest outline of 
treatment. On operative surgery, and pathology in general, we 
have, perhaps, books enough ; and it is time that we apply our 
system to the treatment of surgical affections. That we have not 
yet done so, in the fullest meaning of the word, is evident ; for in 
all our books a few lines are given to remedies, and pages and 
whole chapters to pathology and operative measures. I do not 
mean to undervalue these studies, but, rather to make them subor- 
dinate to therapeutics. Believing that what we now need is a 
work on surgical practice purely Homoeopathic, with the fullest 
indications for the use of the remedies, and that the law of similars, 
the single remedy, and the minimum dose, are just as applicable 
in surgery as anywhere else, the present pages have been written 
to help fill this demand. 

There being then nothing in our literature treating specially 
on surgical therapeutics, I had, at the suggestion of several of 
my professional friends, interleaved a copy of Erichsen, with 
indications for the selection of remedies, intending to procure, 
if possible ', permission to publish a Homoeopathic system of sur- 
gery based on his work. Circumstances operated against this, 



1 8 Introduction, 

however, and the book was finally completed in its present &**.* ; 
therefore, whatever resemblance this may present to Erichsen's 
must be attributed to that fact. The object is simply to present 
reliable indications, gathered from my own clinical experience 
from well-authenticated reported cases, and confirmed symptoms 
from the works of Hahnemann, Lippe, Jahr, Bcenninghausen, 
Guernsey, Raue, and others. 

For the details of operations and measures of expediency there 
is no occasion here, as the works of Erichsen, Gross, Smith, and 
especially the labors of Franklin and Helmuth, have provided us 
with all that we need on those points; and I take pleasure in 
referring to the latter in this connection, and acknowledging how 
much we are indebted to them. 



SURGICAL DISEASES OF THE MIND. 



SHOCK— TRAUMATIC DELIRIUM. 

Shock. 

Shock is a state of depression or nervous prostration present 
after all mechanical injuries, and varies in intensity according to 
the gravity of the accident. 

The symptoms accompanying the immediate results are, cold- 
ness, faintness and trembling ; pulse small, weak and fluttering ; 
the mind is shown to be disordered by the face exhibiting mental 
disquietude, and by anxious and incoherent speech. Death may 
be the result of shock alone. Even in apparently trivial accidents, 
the patient may be in a state of physical or mental depression 
that is sufficient to render the mere shock fatal. 

Remote effects may not exhibit themselves until considerable 
time after the accident. A blow has been received, and weeks, or 
even in some cases months have elapsed, when neuralgia or in- 
flammation is developed, traceable directly to this blow. 

Therapeutics. — The treatment of shock may be moral 
or medicinal. Often, kind and encouraging words will rally the 
patient, without any other treatment. An operation should not 
be performed during the shock ; it is best to wait for a reaction. 
The rule is, in civil practice, wait for reaction ; in military, operate 
as soon as possible after the accident. Many Homoeopathic sur- 
geons ignore altogether the use of our remedies in the treatment 
of shock, depending entirely on stimulants. I have never given 
them for any disease, and trust I never shall. 

The remedies that will be found the most frequently indicated 
are Arnica, Camphor and Opium. Aeon., Ruta, Rhus, may be, 
occasionally. 



20 Surgical Diseases of the Mind. 

Arnica is always more or less useful, and should be admin- 
istered even if you have to use stimulants. I find it the most 
useful where there is diarrhoea. 

Opium is indicated when there is coma; incomplete insensi- 
bility ; the patient will be aroused for a moment on addressing him 
in a loud tone of voice, and then relapses into stupor ; extremities 
and face bluish, or of a livid color ; loud, stertorous respiration, 
and coldness of the skin. 

Camphor is a valuable remedy, and will frequently produce an 
effect when Opium fails. Cold hands and feet, trembling tongue, 
trembling of the hands and feet on raising them up. 

These three remedies have acted beautifully in my hands. As 
I have had the privilege of treating a great number of cases of 
accident, they have had a fair trial. Therefore, I would advise : 
discard all notions of stimulation and stick to Homoeopathy. 

Traumatic Delirium. 

Traumatic Delirium is nothing more than Shock modified 
by existing circumstances. If an individual of a highly nervous 
or irritable disposition receive a great injury, the shock either 
degenerates into a delirium, or this condition is present from the 
first. This delirium is usually of the furious, raving form, though 
it may occur in almost any form. 

There is an another form, " irritative," or " nervous delirium," 
which occurs in persons of a broken-down constitution, and 
resembles very closely delirium tremens. Like this frightful mal- 
ady, it is chiefly confined to drunkards. 

Therapeutics. — In both of these forms we have a variety 
of remedies to choose from. Among the most prominent are 
Aeon., Bell., Bryonia, Cuprum acet., Cuprum met., Ferrum acet., 
Hell., Hyos., Ign., Lach., and Stram. 

A-COnite. Inconsolable lamentations; anguish; piteous howl- 
ings; reproaches from trivial causes; disheartening apprehensions; 
despair ; loud moaning, bitter complaints and reproaches ; palpita- 
tion of the heart; oppressed breathing; increased heat of the 
body and face; great weariness; apprehensions of approaching 
death : a strong tendency to be angry or frightened. 

Belladonna. Melancholy ; great anguish about the heart ; 
merry craziness ; sings and warbles an air; immoderate laughter; 



Special Therapeutics. 2 1 

foolish manners ; violent weeping, moaning and howling ; fearful- 
ness; despondency; dejection of spirits; apathy; great irritability 
of the senses ; rage ; frenzy ; bites everything in his way ; shy 
craziness ; tries to escape ; violent redness of the face ; dark, red 
and bloated face ; shining, sparkling eyes. 

Bryonia* Apprehensions ; uneasiness, and dread on account of 
the future ; vehemence ; cold sweat on the forehead and head ; 
faintness and nausea on sitting up in bed ; has to lie down again *. 
bloated, red and hot face ; delirium about the day's business. 
(Compare Veratrum alb.) 

Cuprum acetic. Great absence of mind; tendency to start; 
the eyes are sunken, staring, as if riveted in the sockets ; cold 
sweat ; spasmodic distortion of the face. 

Cuprum metallicum. Anguish ; restless tossing about and 
constant weariness ; delirium ; attacks of craziness and vertigo ; 
slow pulse ; flushes of heat : colic ; red, inflamed eyes, with wild 
looks ; pale face. 

Ferrum acet.. Vehement; quarrelsome; anxiety; great lan- 
guor ; fainting spells ; coldness ; want of animal heat ; viscid, 
exhausting sweats ; livid or pale face and lips ; sometimes fiery 
red face. 

HellebOPUS nig. Silent melancholy ; involuntary sighing ; obsti- 
nate silence ; spasmodic rigidity of the limbs, with concussive 
shaking of the head ; general sweat ; dulness ; confusion of the 
head ; inability to reflect ; pale face. 

HyOSCyamUS nig. Indomitable rage; horrid anguish; com- 
plains of having been poisoned ; raging ; desire to go naked day 
and night; sleepless; screaming; repeated fainting-fits ; cold and 
sour sweat ; complete stupefaction ; loss of sense ; does not know 
his relatives ; red, sparkling eyes ; staring, distorted eyes ; open 
eyes, distorted in different directions ; bluish face ; cold, pale face ; 
or brown-red, swollen face. 

Ignatia. Great tendency to start ; boldness ; the slightest con- 
tradiction irritates; ill-humor and anger, impatience, irresolute- 
ness; quarrelsome; intolerance of noise; sadness; weeping and 
laughing almost in one breath ; sweat on the face ; face pale, red 
or bluish ; involuntary sighing. 

Lachesis. Feels sad ; discouragement and loathing of life 
mistrustful, suspicious, doubts everything; peevish, fault-finding 
malice ; hurriedness and uneasiness ; great nervous irritability 



22 Surgical Diseases of the Head. 

excessive moaning and complaining of one's pains ; morbid talka- 
tiveness ; small and quick pulse ; distension of the face ; sunken 
face, showing great suffering ; pale face. 

Stramonium. Indomitable rage; talkativeness; great desire 
to bite ; fear ; convulsions ; weariness of the mind ; subsultus ten- 
dinum ; spasmodic movements ; strong pulse ; copious sweat ; 
swollen and red face ; sparkling, glistening eyes ; staring somno- 
lent eyes. 



SURGICAL DISEASES OF THE HEAD. 



Injuries of the Scalp — Compression of the Brain — 
Concussion — Irritation — Traumatic Encephalitis — 
Wounds of the Brain — Hernia Cerebri — Fungus of 
the Dura Mater — Fungus of the Cranium. 

Injuries of the Scalp in manufacturing districts are very 
common, and. although nearly every one knows something about 
their treatment, I have been surprised to see exhibitions of igno- 
rance that were truly lamentable and unpardonable. 

Contusions are the most common, and usually the most simple, 
of all these injuries. They are rarely accompanied with a wound, 
and require but the simplest treatment. Arnica, topically or 
internally, will, in. nearly every instance, effect a cure. When this 
does fail, use Con. in the same manner. When there has been 
much ecchymosis, and the effused blood seems to be firmly coagu- 
lated, it is an irresistable temptation to many to open it and turn 
out the clot. Never do this, as suppuration will surely follow. 
The only time when it would be at all admissible is when suppu- 
ration is already threatening ; then the removal of the clot may be 
useful ; not with the hope of preventing suppuration, but of lessen- 
ing the amount. It sometimes happens that although the blow 
was not sufficient to rupture the skin, yet concussion of the brain 
has followed. Arnica, in this case, is the most important remedy 
we have. (See Concussion.) Depression of the skull, with com- 
pression from it, as well as compression from effusion of blood, or 



Injuries of the Scalp. 23 

lacerated brain, all have occurred with not only the absence of an 
external wound, but even with no signs of an injury to the skin. 

Lacerated wounds are the most common injuries in manu- 
facturing districts, being inflicted by belting of machinery. I have 
seen nearly the whole scalp torn up, and hanging down over the 
patient's face. Under our treatment, these wounds are most 
surely healed, with little or no disfigurement. 

Contused wounds are next in frequency, and are nothing more 
than bad contusions complicated by an external wound. The 
chief dread is that of gangrene and sloughing. Arnica, or per- 
haps Con., will, in nearly every instance, prevent this. 

Incised wounds of the scalp are rarely seen. Wounds, so-called, 
will often be found on examination to be either lacerated or con- 
tused. Should you have such a case, administer Staph., either 
internally or topically. 

Treatment. — The proneness of injuries of the scalp to sup- 
puration renders them a very interesting study. Allopathy has no 
means at her command to prevent suppuration that are at all 
certain ; hence she teaches the certainty of its appearance. They 
are prone to this termination, but seriously, I believe not more 
so than any other injury. Our remedies certainly act like a charm, 
and with their use I have had cases that actually suffered more 
from suppuration after amputations than from scalp wounds. I 
mean, of course, comparatively. 

Remove, first and always, all the hair, by shaving, for some dis- 
tance around the wound. If any arteries spout, close them by 
torsion. Ligatures act as setons, and greatly increase the forma- 
tion of pus. Wash the wound carefully with a weak solution of 
Calendula, Staphisagria or Arnica, according to the nature of the 
wound, i. e., incised, lacerated or contused, and then carefully 
inspect the part, to see if the bone has sustained any injury. 
Never enlarge a wound in this part for the purpose of making it 
a better shape, and, above all, never cut off any ragged pieces, no 
matter how small they may be — fit each one carefully in place. If 
you cut them off, suppuration will surely occur in that spot, and 
as the skin is very loosely attached, it may spread all over the 
head. Draw each little point into its proper place, and secure it 
there by hair-lip pins or silver-wire sutures (silk sutures are as 
objectionable as ligatures). The dressing of the wound is simple : 
support each stitch with narrow strips of adhesive plaster, cover 



24 Surgical Diseases of the Head. 

them with a piece of soft linen, folded three or four thicknesses, 
saturated with a solution of the remedy required; retain the 
whole in place with a t or + bandage. 

Calendula is nearly always sufficient to prevent suppuration, but 
if it fails, open the wound partially to admit the escape of pus, 
otherwise the whole scalp may be dissected up. 

Compression of the Brain. 

Compression of the brain is a term used to designate coma, 
more or less complete ; coldness of the face, head and extremities ; 
clammy perspiration ; a peculiar " pumping " of the larynx and 
trachea ; stertorous respiration ; dilated or contracted pupils, but in 
either case immovable ; frequently frothing at the mouth. Cases 
have been recorded in which none of these conditions were 
present, the patient being in full possession of all his faculties, so 
that no suspicion of compression could be obtained. One of* four 
causes usually operates to produce this state : depressed fracture 
of the skull; extravasated blood, pus, or some effusion into the 
cavity ; the presence of some foreign body, as a bullet ; or the 
growth of tumors. 

Fracture of the skull may be simple or compound. Simple 
fractures are the most common, and the administration of Aeon., 
Am., Calend. or Symph. will aid in perfecting a cure. 

Compound fractures are to be treated on general principles; 
that is, cleanse the wound, tie the vessels, close it and apply the 
bandage ; use Calendula for the wound, which, as soon as it is 
healed, abandon for Symphytum. 

Comminuted fracture is frequently fatal, and, at the best, is a 
very serious lesion. The greatest drawback to a successful termi- 
nation is, that drunken people, or those who from dissipation are 
broken down in health, are the most subject to it. Some time 
usually elapses before you see the case, consequently the irritation 
of the fragments produces serious inflammation of the brain or its 
meninges. Again, the wound you are obliged to make to extract 
the fragments is almost sure to suppurate. If a wound is present 
already, the pieces of bone may be extracted through that ; and, 
if possible, avoid enlarging it any. If you have to make one, first 
shave the scalp closely over the place. After the pieces are all 
removed, the wound cleansed and bleeding stopped, close it, and 



Compression of the Brain, 25 

administer Arnica internally, one dose either dry or in water 
every three or four hours. If the wound is one made by the same 
force that produced the fracture, continue the Arnica, topically 
and internally ; if it is one you have made, use Staphisagria 6 top- 
ically, one drop to the ounce, and the 6th or 30th internally. 

Extravasated blood may produce compression, either by being 
caused by the fracture or from the rupture of some vessel with no 
fracture. I say trephine over the place injured, and let it out. 
The same rule applies to suppurations, or any of the effusions, 
hydrocephalus excepted. The brain is peculiarly liable to extensive 
suppuration, and when once it commences, it is almost impossible 
to arrest it. Therefore, trephine, and let the pus or blood out. 

Foreign bodies must be extracted, if it can be done without 
injuring the substance of the brain too much. When the patient 
has no symptoms of compression, but has received a severe blow 
on the head, complaining of constant pain and uneasiness, a careful 
examination must be made ; and if no depression be found, the 
presumption is that there is an extravasation of blood. Arnica 
will usually produce an absorption of this ; sometimes, Conium. 
When, with the same absence of fracture, there are symptoms of 
compression, the same diagnosis may be made, but the indica- 
tions are to let the blood escape by opening the skull if relief does 
not follow the use of Arnica, etc. If after one or two days the 
pain has diminished, and suddenly there is a chill, followed by 
absence of pain or a gradual return to consciousness, succeeded by 
beating, throbbing and heat, it may be inferred that suppuration 
has set in, and the trephine will be needed to allow the pus to 
escape. 

Compression may exist without coma, and coma without fract- 
ure, as has been shown above. Therefore, be very thorough in 
examination, and if a depression positively exists, cut down, tre- 
phine, and elevate immediately. Here a little skill is necessary, to 
determine if what appears to be a depression is really one or not. 
A physician whom I assisted at one time was positive he had a 
depression to deal with, but on cutting down he found that it was 
merely a laceration (subcutaneous) of the temporal muscle, with 
the bone intact. Ecchymosis, or a torn muscle with a wide 
retraction of the edges, may often deceive. Dr. S. C. Williams, 
of North Vassalboro, Maine, told me that he had treated, suc- 
cessfully, four cases of depressed fracture of the skull with Arnica 



26 Surgical Diseases of the Head. 

30 alone. He claimed that there was elasticity enough in the 
membranes to raise this depression, if they were properly set to 
work. I give this for what it is worth. I believe it, 

A dose or two of Aconite, followed by Symphytum in a high 
attenuation, had better be used after the operation. If there are 
no ligatures used, Calend. had better be given to close the wound. 
Use no stitches unless they be of silver, but apply only adhesive 
strips and light bandaging. Keep the patient perfectly quiet, 
mentally and physically, and keep him on light diet. No stimu- 
lants, and no coffee. Watch him very carefully, for serious 
diseases of the brain are apt to follow. 

Concussion. 

Concussion of the brain, commonly known as stunning, may 
be caused by a fall, a blow, or a jar. The more constant symptoms 
are manifested in two stages; the first, ox primary group are, insen- 
sibility more or less complete ; the patient answering if spoken to 
in a loud voice, but soon relapsing into insensibility again ; pulse 
scarcely perceptible ; sphincters relaxed ; cold surface ; limbs 
relaxed ; dilated, immovable pupils. The secondary or reactionary 
stage, the circulation becomes re-established; the surface conse- 
quently warmer ; return of consciousness, and, generally, vomiting. 
After, this reaction goes on rapidly, and quite often goes too far, 
resulting in encephalitis, or some kindred affection, of which more 
will be said further on. The substance of the brain is frequently 
disorganized in severe concussions, and an autopsy reveals a dif- 
fluent mass. Sometimes simple rupture of this organ is produced, 
which, from the resulting haemorrhage, causes compression. In all 
bad cases it is best in forming the prognosis to consider that in 
grave cases some such lesion is apt to exist, and therefore ultimate 
recovery is very doubtful. 

Irritation. 

Irritation of the brain occurs very frequently in connection 
with injuries of the head. It is a very serious matter, and to 
irregular practitioners one that usually proves fatal. Even under 
our own treatment, the results are not as gratifying as we could 



Traumatic Encephalitis. 27 

wish in every instance. It is often accompanied by laceration of 
the brain, and frequently occurs in connection with compression 
and concussion. Erichsen gives the briefest catalogue of symp- 
toms. " The patient lies in a state of semi-consciousness, unob- 
servant of what is going on around him, unless spoken to or 
aroused. He does not, however, lie quietly, but moans, turns 
himself about, and not unfrequently twists and curls himself for- 
ward, with the back bent, and the knees drawn up towards the 
chest. On being spoken to, he answers in a peevish, irritable 
manner, if at all, frequently frowning and distorting his counte- 
nance, and being evidently pained at any attempt to fix his atten- 
tion. He is occasionally convulsed, and at other times is seized 
with fits of violent delirium, shouting and screaming. The pulse 
is usually slow and feeble, skin cool, and the face pale, with total 
absence of all signs of inflammation." The treatment for all these 
lesions will be given together. Suffice it to say here, that no acute 
disease will be found so hard to treat as this ; you must expect 
failure. 

Traumatic Encephalitis. 

Traumatic encephalitis, in common with irritation, is pro- 
duced by injuries, the nature of which, with the extent of the 
lesion, determines the gravity of the case. It is extremely diffi- 
cult to diagnose, for what seems encephalitis may be suppuration. 
At all events, as Erichsen says, " the symptoms become so mixed 
up with those of compression and irritation as to make the exact 
diagnosis of the patient's condition far from easy." The more 
constant symptoms are coma, or constant delirium ; fullness and 
redness of the face and eyes ; beating and strong throbbing of the 
carotids and temporal arteries. A symptom more diagnostic than 
almost any other is an involuntary attempt to hold the head with 
the hands. The pain accompanying inflammation of the substance 
of this organ is not nearly so acute as that accompanying inflam- 
mation of the membranes. Vomiting is also present, and is quite 
constant and obstinate. Heat is complained of in the head, while 
the rest of the body is cool. Altogether, it is a very distressing 
and serious disease, but is not so fatal under our treatment as 
irritation. 



28 Surgical Diseases of the Head. 



Wounds of the Brain. 

Wounds of the brain, of course, may be of any variety, but 
the lacerated is probably the most common. From them may 
proceed either irritation or traumatic encephalitis, or both, as well 
as compression. Close the wound in the skull, if such exist, and 
prevent inflammation, or inflammation running into suppuration. 

The best treatment to be pursued is to give Aconite to combat 
the immediate effects, followed by Calend. if the wound is punc- 
tured or lacerated, Arnica if contused, Staph, if incised. After 
all danger of encephalitis or suppuration has passed, the use of 
Symphytum will produce a reunion of the fractured bone, or a 
provisional closure of any opening that may exist. 



Hernia Cerebri. 

Hernia cerebri is a complication of fractured skull, which, in 
civil practice, is happily rare. Out of a great number of these 
cases, I have seen but one with this complication. When a large 
portion of the cranium is beaten in, and the portion of bone 
removed, or where there is a long fissure, with great gaping of the 
edges, a fungous-looking mass will be detected projecting from 
the opening, pulsating synchronously with the brain, and com- 
posed of disintegrated cerebral substance. This is a very dan- 
gerous complication, and the treatment is very unsatisfactory. In 
common with the old school, we are obliged to shave off the mass, 
and, as it returns, do so again. To this we add the use of Aeon., 
followed by Calend. Some claim perfect success ; my patient 
died. The fissure of the bone must be brought as near as 
possible together, and after all danger of encephalitis or suppura- 
tion is passed, Symphytum is to be given, to promote bony union. 
When a piece of the skull is entirely removed, bandage the head 
firmly, and place a compress over the opening saturated with a 
very weak solution of Calendula. Of course, the hair immediately 
surrounding the wound is to be all removed . 



Fungus of the Cranium. 29 



Fungus of the Dura Mater. 

These fungi are tumors growing from some part of the dura 
mater, due generally to an injury, a fall or blow; sometimes, how- 
ever, they appear without any assignable cause. Sooner or later 
the bone covering the tumor is absorbed, and a protrusion of the 
mass is noticed immediately under the skin. Until this time there 
is no certainty in the diagnosis, and, for that matter, there is none 
even then. The position may be immediately over some one of the 
principal arteries, and its symptoms and appearance may readily 
lead one to suppose that he has to deal with an aneurism. There 
is perceptible pulsation, and the mass may be quite readily pressed 
back into the cavity of the cranium. There are no constant gen- 
eral symptoms. Usually, symptoms of compression are noticed, 
and as they, for the most part, occur prior to the absorption of the 
bone, you can not tell what may be the cause. Indeed, it is not 
until the bone is very much thinned, and there is considerable 
prominence at that point, that you can find anything to lead you 
to suspect the true cause of all the trouble. Indications of some 
grave cerebral disturbances are usually found, such as epilepsy, 
syncope, double vision, deafness, but occasionally no such symp- 
toms are seen, and until the tumor is fully developed nothing 
unusual in the patient's health may be noticed. When the bone 
is perforated, any attempt to push back the mass is accompanied 
by giddiness, syncope, and, sometimes, convulsions. The chances 
of effecting a cure are slight. 

Fungus of the Cranium. 

This is a growth similar in external appearances to the last 
variety, but differs from it in many essential points. It grows 
directly from the cranium, is devoid of pulsation, and can not be 
pushed back. It is vascular in structure, resembling the pulp of 
a red gooseberry, or broken down mulberry. The treatment by 
medicine offers better prospects than the preceding, but if reme- 
dies should fail, operative measures are reasonably certain. 

The remedies that may be found useful in fungi are mentioned 
here suggestively only, as I am not certain that a cure has ever 
been effected; in short, I know of no case in which the attempt 



30 Surgical Diseases of the Head. 

has been made. Why they should not be curable, it is hard to 
tell. The remedies are as follows: Aeon., Am., Ars., Aur., Bell., 
Calc. c, Calc. ph., Con., Hep., Iod., Merc., Phos., Rhus, Ruta, 
Secale, Si/., Sulph., Thuja. 

Treatment. — The remedies for the different conditions may- 
be stated as follows : 
Compression. — Am., Con, 
Concussion. — Am., Bell., Calend., Cicuta, Con., Gelsem., Hyos., 

Rhus, Sir am. 
Irritation of the Brain. — Am., Con., Lach., Staph. 
Traumatic Encephalitis. — Aeon., Am., Bell., Cupr. acet., Hyos., 

Merc., Opium, Stram.j Ars., Bry., Hell., Lach., Rhus, 

Zinc. 
Fungus of the Dura Mater: 

Traumatic. — Aeon., Am., Bell., Con., Hep., Rhus, 

Ruta. 

Idiopathic. — Calc. c, Calc. phos., Phos., Sulph., Bell., 

Secale. 

Congenital. — Calc, Phos. 

Fungus of the Cranium. — Ars., Aur., Bell., Calc, Con., Hep., 
Iod., Merc, Rhus, Ruta, Sulph., Sil., Thuja. 

As but little can be learned from patients suffering with any of 
these diseases, if such they may be called, we shall have to con- 
fine ourselves as much as possible to objective symptoms. 

Aconitum nap. Sensitive irritability; fitful mood, changing 
from one thing to another ; sensation of fullness and heaviness in 
the forehead, with the sensation as if the whole brain would start 
out of the eyes, with nausea and giddiness ; aversion to, or great 
desire for light ; red and hot face ; red and pale alternately ; red- 
ness of one cheek and paleness of the other; when rising up the 
red face becomes pale; perspiration of the side of the face on 
which he lies. 

Worse in the evening and night ; also when lying on the left 
side, when rising, and when the room is warm. 

Better in the open air, or when he is in fresh air, with the win- 
dows open. 

Arnica mont. Declines to answer any questions ; giddiness and 
nausea when moving and rising; burning heat in the head, the 
rest of the body is cool ; sunken, pale face ; redness of one 



Fungus of the Cranium. 31 

cheek; hot, red, shining swelling of one cheek; twitching of the 
muscles. 

Worse in the morning, evening and 'night; also from moving 
the head. 

Better from contact, even from noise. 

Arsenicum alb. Delirium; great prostration, with diarrhoea; 
tearing in the head, with vomiting when raising it up ; erysipelas 
of the head, with burning ; general weakness and coldness ; the 
eyes and lips are much inflamed; excessive photophobia; puffi- 
ness of the face, especially round the eyes ; pale, earthy face ; 
distorted features; death-like countenance; thirst for small quan- 
tities, often. 

Worse at night, after midnight, and in the morning ; also from 
cold, cold drinks, lying with the head low. 

Better from heat in general, and lying with the head high. 

Aurum fol. Melancholy mood, dejected, inclined to weep, and 
longing to die ; sensation as if a current of air were rushing 
through the head, if it be not kept warm ; the bones of the skull 
are painful, especially when lying down ; vertical half sight ; over 
sensitive to all pain, and to the cold air; hysterical spasms, with 
laughing and crying alternately. 

Worse in the morning ; also on getting cold, and while reposing. 

Better from moving, while walking, and on getting warm. 
Right side. 

Belladonna. Delirium ; disinclination to talk, or very fast 
talking; loss of consciousness; blood vessels on the head and 
neck enlarged ; boring into the pillow ; shaking the head ; smooth, 
erysipelatous, hot swelling, first of the face, then extending over 
the whole head, with stupefaction and delirium, violent headache 
and fiery eyes ; purple, red, hot, or yellow color of the face ; face 
pale and sunken, with distorted, anxious countenance ; alternate 
redness and paleness of the face. 

Worse in the afternoon, and at night, after midnight ; also on 
moving, from touching the parts, even softly. 

Better from leaning the head against something. 

Bryonia alba. Exceedingly irritable, and inclined to be angry ; 
heat of the head, with dark red face (dusky color of face) ; cold- 
ness of the rest of the body ; does not drink often, but much at a 
time; pain in the limbs on moving them; inflammation of the 
eyes with swelling of the lids; yellow, pale face; or hot, red, 
bloated face. 



32 Surgical Diseases of the Head, 

Worse in the morning, and in the evening ; also from motion, 
and on sitting up in bed. 

Better while lying down, and on getting warm in bed. 

Calcarea Carb. Thinking is difficult; easily frightened or 
offended ; fullness and heaviness in the head ; internal and ex- 
ternal sensation of coldness on one side of the head, as if a piece 
of ice were lying there, with pale puffed face ; great weakness and 
debility from a short walk, or from talking; epileptic attacks at 
night ; fainting, with loss of sight and coldness ; sleepy the whole 
day, and in the evening ; falls asleep late ; sleeplessness. 

Worse in the morning, and in the evening ; also in the cold air, 
in the open air, and in wet weather. 

Better while lying down on the painful side, and after lying 
down. Right side. 

Calcarea phos. Vertigo and nausea; headache, with flatulency; 
dullness, painfulness and Tieavmess in the head, early in the morn- 
ing, on awakening ; painful feeling of fullness in the head ; -sensa- 
tion as if the brain were pressed against the skull. 

Worse in the open air, from motion, on being touched, from the 
warmth of the room, and on stooping. 

Calendula Off. Symptoms of compression, with no fracture. 

Cicuta, Concussion, followed by tonic spasms, and where the 
base of the brain is the chief point of suffering. 

Conium mac. Inclination to start, as from fright ; very forget- 
ful, can not recall things ; giddiness when looking around ; vertigo 
on turning the head in bed ; aversion to light, without inflamma- 
tion of the eyes ; things look red ; sickly, pale face ; pale, purple, 
bloated face ; heat in the face. 

Worse in the night ; also, from being uncovered, and from light. 

Better from wrapping up warmly 

Cuprum acet. Delirium ; incoherent talking ; the head is 
twisted to one side, falls forward; the head is moved from one 
side to the other ; eyes fixed, staring, sunken ; or protruded, 
glistening eyes ; eyes turned upwards ; distended muscles of the 
face ; fullness of the face ; changed features, full of anguish ; 
bluish face, with bluish lips. 

Worse from contact. 

Gelseminum. Paralysis, as one of the remote consequences, 
in persons of lax fibre. 

Glonoine, Giddiness when the head is moved ; fullness in the 



Special Therapeutics. 33 

head, as if the brain was expanding itself, was moving in waves ; 
pulsative headache ; the more frequent the pulse the more severe 
the pains ; paraplegia. 

HelleborilS nig. Silent melancholy, with great anguish, much 
moaning, thoughtless staring, and inability to think ; loss of mem- 
ory ; stupefaction, and boring with the head in the pillow ; staring 
look ; photophobia, without inflammation ; pale, yellowish color 
of the face ; very dark urine, sediment like coffee-grounds. 

Worse in the evening ; also from cold air, and motion of the body. 

Better from waimth. 

Hepar Slllptl. Over sensitiveness, with irritability; quick, 
hasty speech ; fainting ; giddiness when riding in carriage, or when 
shaking the head ; cold, clammy perspiration, smelling sour, prin- 
cipally on the head and face, with aversion to be uncovered ; nodos- 
ities on the head, sore to contact; photophobia; objects appear 
red ; fainting from slight pains ; weakness in all the limbs, they 
feel bruised; restless and soporous slumber, with the head bent 
backward. 

Worse at night ; also from cold, from lying on the painful side ; 
from pressure, and on touching the parts ; from single parts getting 
cold. 

Better from warmth. Left side. 

Hypericum per. Convulsions from blows on the head; dull 
headache, on the vertex, or severe headache, with a beating (ham- 
mering) on the top of the head ; heat, with delirium ; wild, staring 
look ; hot head ; throbbing of the carotids ; bright red, bloated 
face ; moist hair on the head, and burning heat of body ; great 
oppression and anguish ; violent, excruciating pain from lacerated 
nerves. 

HyoSCyaniUS nig. Delirium, without consciousness; does not 
know anybody, and has no wants except thirst ; when spoken to, 
he gives proper answers, but speedily relapses into delirium and 
unconsciousness ; loss of memory ; pulsation of the arteries so 
violent that the head shakes ; the head is shaken or drawn to one 
side, with loss of consciousness and red, sparkling eyes ; contortion 
of the eyes ; heat and redness of the face ; swollen, brown-red 
face ; distorted, bluish face, with mouth wide open ; great pros- 
tration. 

Worse in the evening; also from being uncovered, and from 
moving. 



34 Surgical Diseases of the Head. 

Better from wrapping up and from warmth. 

lodium. Restlessness, with an inclination to move about, not 
permitting one to sit or sleep ; throbbing in the head on every 
motion ; obscuration of sight ; double vision ; sensitiveness to noise ; 
hardness of hearing ; buzzing in the ears ; great debility, even 
talking causes perspiration ; great emaciation ; restless sleep, with 
vivid or anxious dreams. 

Worse in the evening, and at night; also, when lying on the 
painful side, from pressure, and from warmth. 

Better from cold. Right side. 

Lachesis. Nervous irritability; paleness, yellowishness or lead- 
like color of the face ; heat and redness of the otherwise pale face ; 
contraction of the muscles. 

Worse in the evening, and at night, before midnight ; also, after 
sleep, from moving, or changing the position. 

Better on shaking the head. 

Mercurius SOl. Continuous moaning and groaning; hurried 
speech; weakness of memory, forgets everything; vertigo, as if 
one were in a swing ; aversion to light ; inflammation of the scle- 
rotic ; eyes dim, and without lustre ; pale, yellow, earthy color of 
the face ; heat and redness of the cheeks ; profuse sweat, not reliev- 
ing the symptoms. 

Worse in the evening, and at night ; also, from being in a 
draught, and on getting warm in bed. 

Better in the morning, and when lying down. 

Opium. Stupefaction of the senses ; loquacious delirium, with 
open eyes and red face ; complete loss of consciousness and sensa- 
tion, with relaxation of the muscles ; pulsation in the head ; eyes 
half open, and turned upward; pupils dilated, and insensible to 
light : glassy, protruded, immovable eyes ; face is bloated, dark-red 
and hot ; face pale, clay-colored, sunken, with red spots on the 
cheeks; bluish face; the muscles of the face relaxed; the lower 
lip hangs down ; stertorous breathing. 

Worse when wrapped up warm. 

Better ? 

Phosphorus. Vertigo when rising from the bed in the morning, 
when rising from a seat, with fainting and falling to the floor ; 
sensation of emptiness in the head, with vertigo; sensation of 
coldness in the cerebellum, with sensation of stiffness in the brain ; 
mistiness of sight ; momentary loss of sight, as from fainting ; 



Special Therapeutics. 35 

hardness of hearing, especially of the human voice ; roaring before 
the ears ; great emaciation ; nervous debility ; trembling in all the 
limbs from the least exertion ; sleepiness in the day-time ; long 
time in getting asleep ; wakes frequently. 

Worse in the evening and at night; also, when lying on the 
back, or left side, when rising from a seat, and from change ot 
weather. 

Better when lying on the right side, when rubbing, and after 
sleeping. Left side. 

Rllta grav. Anxious and low-spirited, with mental dejection; 
giddiness in the morning, when rising, when sitting and when 
walking in the open air; great heat in the head, with much rest- 
lessness ; the head is externally painful, as if bruised or beaten ; a 
green halo appears around the light in the evening. 

Worse during rest, and in cold, wet weather. 

Better by motion. Left side. 

Secale COr. Great anxiety ; fear of death ; stupefaction, and 
unconsciousness ; giddiness, as from intoxication ; double vision ; 
obscuration of sight ; humming and roaring in the ears, with occa- 
sional deafness ; tetanic spasms ; great sleepiness ; deep and heavy 
sleep. 

Worse at night ; also, from motion, from touching the part, when 
walking, from warmth, and from the heat of the bed. 

Better from cold, and while standing. Either side. 

Silicea. Desponding, melancholy, tired of life ; vertigo, as if 
one would fall forward, when stooping, riding, raising the eyes 
upward, ascending from the neck to the head, with nausea ; burn- 
ing in the head, with pulsations in and sweat on the head ; obscu- 
ration of sight, as from a gray cover ; aversion to light ; daylight 
dazzles the eyes; difficult hearing, especially of the human voice; 
over-sensitiveness of the hearing to noise ; epileptic attacks at 
night; frequent jerks and startings during sleep. 

Worse in the night ; also, in the open air, from cold, on getting 
wet, when lying on the painful side, from external pressure, and 
from change of weather. 

Better from warmth. Right side (?). 

Sulphur. Vertigo when sitting, stooping, when rising from the 
bed and in the morning, with vanishing of sight and inclination 
to fall on the left side ; he feels every step painful in the head ; 
feeling of coldness about the head; obscuration of sight, like 



36 Surgical Diseases of the Head. 

gauze before the eyes ; humming in the ears ; hardness of hearing, 
or over-sensitiveness ; humming or buzzing in the head ; rouses 
from sleep or stupor in a somnambulic state ; great debility and 
trembling ; talking fatigues. 

Worse in the evening, and at night ; also, on getting warm in 
bed, on rising, from bodily exertion, on talking, while standing and 
on touching the part. 

Better during motion, when lying on the right side, from heat, 
and in dry weather. Left side. 

Ttlllja OCCi. Thoughtlessness ; forgetfulness ; vertigo on closing 
the eyes — disappears as soon as he opens them — or, on stooping 
or on looking upwards or sideways ; obscure sight ; weakness of 
the sight ; double vision ; in the dark, it seems as if there were 
luminous lights or sparks falling down alongside of the eyes — in 
the day-time, it is like dark drops ; noise in the ears, as if from 
boiling water; sleeplessness, on account of heat and restlessness. 

Worse in the evening, at night, and in the morning ; also, from 
cold and wet, and the heat of the bed. 

Better from warm wet. Left side. 

Rhus tOX. Absence of mind; illusions of the fancy; fullness 
and heaviness in the head, especially in the forehead, with sensa- 
tion as if a weight were falling forward on stooping, with heat in 
the face ; erysipelas of the head and face, with vesicles drying up, 
and forming burning-itching scabs ; erysipelas of the eyes, and of 
the skin around them ; aversion to light ; face pale and sunken, 
with blue rings under the eyes, and pointed nose. 

Worse in the morning, after midnight; also, from cold, cold 
water, and uncovering the head. 

Better from moving the parts, from warmth, and on wrapping 
the head up warmly. 

Staphisagria. Weakness of memory; rejects angrily whatever 
is put into his hand ; stupefying, pressing headache, as if the brain 
were compressed ; sensation as if the head would burst, particu- 
larly in the forehead ; countenance sunken ; nose peaked ; eyes 
sunken, and blue margins around them. • 

Worse at night, before midnight; also, on being touched. 

Better from warmth. 

Stramonium. Loquacious delirium and mania; insensibility to 
mental depressions ; stupefaction, with vanishing of vision and 
hearing, and convulsive movements of the head; red, inflamed 



Wounds of the Face. 37 

swollen eyes; staring, glistening eyes; contortion of the eyes and 
eyelids; pupils dilated and insensible; objects appear blue; red, 
swollen, turgid face ; stupid, distorted countenance ; anxiety and 
fear is expressed in the countenance ; distortion of the mouth. 

Worse in the morning ; also on being touched, from looking at 
shining objects, and on being alone. 

Better from bright light. 

Zincum met. Morose, and indisposed to talk ; great aversion 
to the talk of others, and to all noise ; weakness of memory ; 
sensation of soreness in the head ; pressure on the eyes, they feel 
as if they were pressed into the head ; when lifting up the eyes, 
he sees numerous flakes ; paleness of the face. 

Worse in the afternoon ; also, in a warm room. 

Better from cool air. 



SURGICAL DISEASES OF THE FACE. 

WOUNDS OF THE FACE — SALIVARY FISTULA. 

Injuries to the face are of more importance than those of other 
situations, principally from the marring of the features from ugly 
and contracted cicatrices. To the female portion of the commu- 
nity, this is particularly important. 

Wounds of the Face. 

The most common injuries are wounds and bruises. 

Treatment. — The indications to be fulfilled are, 1st, pro- 
mote union by "first intention," if possible; 2d, if this fails, 
prevent the formation of pus ; 3d, if such an event should occur, 
make as neat a scar as circumstances will allow. 

The first of these indications can almost always be attained, if 
the patient applies to you early, by the use of the Homoeopathic 
remedy corresponding to the kind of wound. First, cleanse the 
wound thoroughly. Arrest the haemorrhage by acupressure or 



38 Surgical Diseases of the Face. 

torsion. When the haemorrhage has ceased entirely, and the 
wound is perfectly dry, draw the edges together with fine hare-lip 
pins ; or, if the wound does not gape much, use no sutures ; only 
adhesive strips : choose of these, those of isinglass plaster. The 
edges must come together everywhere ; leave no part unsupported. 
Calendula will usually prevent the formation of pus, but sometimes 
fails. When this occurs, give Hep. 6 often, say once in two hours. 
As soon as the first sign of pus is seen, open the wound again. 
Here the rule of early opening is of particular force ; if it be 
neglected, injury to the bone, or sloughing of a comparatively 
large portion of the skin, will ensue. This early opening does not 
positively ensure a good scar; it only lessens the danger of a 
bad one. 



Salivary Fistula. 

Wounds about the face occasionally result in what is called 
"salivary fistula" "The parotid duct is cut across, in conse- 
quence of which the wound does not close, a trickling of saliva 
taking place on the outside of the cheek," the surface surround- 
ing it being puckered, and somewhat excoriated. 

Treatment. — Various remedies have been proposed to cure 
this, but I doubt their efficacy; they are Caust., Merc, Petrol. , 
Phos. and Sil. The question of an easy cure by any means 
depends upon the condition of the fistula. If the natural open- 
ing is closed, it must be re-established before a cure can result. 
This is best done by passing a small seton through the canal, and 
withdrawing it as soon as a passage is open for the saliva. When 
this has been accomplished, or the canal is open all through, 
freshen the edges, and close it by keeping up firm pressure. It 
may sometimes be necessary to dissect out the callous lining of 
the canal before it will close 



Otitis — Otorrkcea . 3 9 



SURGICAL DISEASES OF THE EAR. 



OTITIS — OTORRHGEA — DEAFNESS — VARIOUS 

DISEASES. 

Otitis. 

Otitis is an inflammation of the external ear, characterized by 
one-sided headache, heat and throbbing; there is usually noise 
and throbbing in the ear. The terminations are, an abscess ; an 
intractable ulcer; or, what may be called "resolution." It has 
sometimes, though rarely, occurred that encephalitis results from 
this disease, when the symptoms are very severe. 

Otitis is either acute of chronic. The former is very readily 
cured, and is a simple inflammation, usually dryness of, and severe 
throbbing in the ear, accompanied by heat. The chronic form, 
says Dunglison, "is often incurable." This only applies, how- 
ever, to old school medication. We hear it spoken of, sometimes, 
as Otalgia. It is characterized by a profuse discharge from the 
ear, but, in other respects, is similar to otitis of the acute form, 
with the prominent symptoms, such as heat and pain, much modi- 
fied in severity. 

Otorrhgea. 

Otorrhoea is a disease peculiar to children of a scrofulous dia- 
thesis, and is characterized by a discharge of fetid, muco-purulent 
matter from the ear. We have two varieties here, that are due to 
inflammation of the mucous surface of the ear, resulting as sequelae, 
from colds, etc., also from a disease of the bones in the vicinity, 
necrosis commonly. If from disease of the bones, it is necessarily 
of a far more serious character, and the membranes at the base 



40 Surgical Diseases of the Ear. 

of the brain become irritated, and convulsions and death usually 
eventually result. In some cases, phlebitis of the sinuses and of 
the cerebral veins ensues, and proves fatal (Erichsen.) Especially 
of inflammation of the dura mater resulting from otitis or otorrhcea 
of the internal ear, and of the petrous portion of the temporal 
bone, Watson says, "sometimes acute inflammation arises within 
the tympanum, when there has been no previous disease ; the 
patient has severe headache and earache; at length a gush of 
matter comes from the external meatus, but the pain does not, as 
it usually does in such cases, cease ; it continues, or even increases 
in intensity ; the patient begins to shiver ; he becomes dull and 
drowsy ; slight delirium, perhaps, occurs ; and, by degrees, he sinks 
into stupor. In some instances, no pus issues externally. More 
commonly, symptoms of the same kind supervene upon a chronic 
discharge of purulent matter from the ear. It is scarcely possible 
to sketch an accurate general picture of this insidious, but most 
dangerous, complaint." What we hear spoken of so frequently as 
" gathering in the head," is otorrhcea, and trifling as it is in many 
cases we have seen, it may be a very serious affair. 



Deafness. 

Deafness may be partial or complete, owing to one of the fol- 
lowing conditions: thickening of the inner cuticle of the ear, 
other obstructions in the external ear from disease, ulceration and 
perforation of the tympanum, paralysis of the acoustic nerve, and 
from obstruction in the eustachian tube. The causes that operate 
to produce these different conditions are the repercussion of 
eruptions, the result of measles, scarlatina, or small-pox ; from 
the abuse of mercury, and from the sudden arrest of a discharge 
from the ears, as in otorrhcea. 

Deafness not dependent upon some organic lesion of the organs 
of hearing, is known as either congestive, rheumatic or nervous* 
Toynbee, in his "Aural Surgery," speaks of many of the so-called 
cases of nervous deafness as quite curable, as they are due to 
inflammation of the lining membranes of the ear. 

In nearly all cases, save some few due to organic lesion, our 
remedies, properly applied, are capable of producing complete 
success. 



Special Therapeutics. 4 1 

Various Diseases 

Various diseases, tumors, ulcers, polypi concretions, etc., are 
met with in the ear as often as in other locations, and need no 
farther mention. See " Tumors and Ulcers," if all that is needed 
for their treatment is not found here. 

Foreign bodies are frequently introduced into the ear, and give 
rise to considerable annoyance. They may prove the exciting 
cause for very destructive inflammations. They are quite readily 
removed, unless their long presence has caused thickening of the 
mucous membrane. In this case, that condition must be over- 
come, or, if it is chronic, the body must be broken up with a drill, 
and removed piece-meal. 

Therapeutics. — The remedies of service in these dis- 
eases are as follows : Aeon., Alum., Anac, Am., Asa/., Asar., 
Aur., Baryta, Bell., Borax, Bry., Calc. c., Calc. phos., Car bo 
v., Caust., Cham., Chin., Cieuta, Cistus caii., Coff., Colch., Dulc, 
Graph., Hep., Hyos., Kali c., Kreos., Lach., Led., Leptan., Lye, 
Mang., Menyan., Merc., Nat. m., Nit. ac., Nux vom., Petrol., 
Phos., Puis., Si I., Stan., Staph., Sulph., Verat. 

They may be arranged in the form of an index, as follows : 

Otitis — Aeon., Apis, Am., Asar., Bell., Borax, Bry., Calc., 

Caust., Cham., Chin., Dulc, Merc, Nux v., Puis., Sulph. 

Erysipelas of the Outer Ear. — Bell. 

Chronic Inflammation of the Ear. — Alum., Baryt., Con., 
Hep., Kali, Kreos., Lye, Phos., Stan. 

Ulceration of the Ear. — (See Ulcers.) 

Otorrhcea : 

with Polypi. — Calc. c, Calc. phos., Sulph., Staph. 

with Glandular Swellings. — Merc, Puis. 

with Cephalalgia. — Bell., Bry. 

with Fever. — Bell., Bry. 

with Orchitis. — Merc, Nux v., Puis. 

from Otitis. — Calc, Merc, Puis., Sulph. 

from Abuse of Mercury. — Asa/., Aur., Nit. ac, Sil., 

Sulph., Hep. 

from Abuse of Sulphur. — Merc, Puis. 

from Caries. — Aur., Nat. m., Sil. 

from a Chill. — Dulc, Merc. 

Catarrhal, or Mucous. — Bell., Merc, Puis., Sulph. 



.42 Surgical Diseases of the Ear. 

Otorrhcea : Purulent. — Bell., Hep., Merc, Puis., Sulph., Asa/., 

Calc, Lack., Nit. ac, Petrol., Sil. 
Foetid. — Aur., Carbo v., Hep. s., Sil., Sulph. 

Sanguineous. — Cicuta v., Merc, Puis., Sil. 

Scrofulous. — Asa/., Aur., Caust., Kreos., Sulph. 

after Exanthemata. — Puis., Mang., Bell., Colch., Hep. s., 

Lye, Menyanth., Merc. 

Effects of Suppression of. — Bell., Bry., Dulc, Merc, 



Nux v., Puis. 
Polypi in the Ear. — Calc. c, Calcphos., Sulph. 
Deafness — Congestive. — Aur., Bell., Graph., Merc, P has., Sil. 

Nervous. — Caust., Petrol., Phos. 

Catarrhal or Rheumatic, caused by a Chill. — Ars., Bell., 

Ledum, Merc, Puis. 

from Suppressed Eruptions. — Sulph., Caust., Graph., 

Mezer. 

from Measles. — Ca?'bo v., Puis. 

from Scarlatina. — Bell., Hep. 

from Small-pox. — Merc, Sulph. 

from Abuse of Quinine. — Calc, Puis., Carbo v., Hep., 

Nux v., Sulph. 
from Abuse of Mercury. — Asa/., Nil. ac, Staph. 

from Hypertrophy of Tonsils. — Aur., Merc, Nit. ac, 

Staph. 

from Fevers. — Am., Phos., Verat. 

from Suppressed Discharge from Nose or Ear. — Hep., 



Lach., Led., Bell., Merc, Puis. 

In giving the special indications, the symptoms of the ear alone 
will be given, as the general symptoms may embrace the whole 
Materia Medica. These should, however, also be consulted when 
the choice is not very clear. 

Aconite nap. Tearing in the left ear; roaring in the ears; 
hearing very sensitive ; noise is intolerable. 

Worse in the evening; also, when lying on the left side, when 
rising, and when in a warm room. 

Better in the open air, and when sitting still. 

Alumina. Stitches in the left ear, in the evening; one ear hot 
and red ; the ear feels as if it had become larger. 

Worse in the evening, and on alternate days; also, when sitting. 

Better in the open air. 



Special Therapeutics. 43 

Anacardilim. Pressing in the ears, as from a plug; itching in 
the ear; hardness of hearing. 

Worse in the morning ; also, when lying on the side, and from 
rubbing. 

Better during dinner. Left side. 

Arnica mon. Stitches in and behind the ears; pains in the ears, 
as if from a bruise. 

Worse in the morning, evening, or at night ; also, on moving, 
from being touched, and from cold. 

Better from motion. Left side. 

Apis mel. Otitis, with stinging pains in the ear. 

Asafcetida. Hardness of hearing, with discharge of pus from 
the ears. 

Worse in the afternoon and evening ; also, when sitting still. 

Better in the open air. Left side. 

Asarum Elirop. Pressure and tension in the region of the 
orifice of the meatus auditorium ; pain, as if from contraction, 
behind the ears. 

Worse in the evening ; also, in cold and dry weather. 

Better from wetting the part with cold water. Right side ? 

Aurum fol. Caries of the mastoid process of the temporal 
bone; foetid otorrhoea; roaring in the ears; over-sensitiveness to 
the pain, and to cold air. 

Worse in the morning ; also, from cold, and while reposing. 

Better from moving, while walking, and on getting warm. Left 
side. 

Baryta Carb. Cracking in the ears when swallowing, when 
sneezing, and when walking fast. 

Worse at night ; also, when lying on the painful side, or when 
thinking of the disease. 

Better when walking in the open air. Right side? 

Belladonna. Inflammation of the external and internal ear, 
with discharge of pus; stinging in and behind the ears; humming 
and roaring in the ears ; paralysis of the auditory nerve. 

Worse in the afternoon and at night; also, from moving, on 
touching the parts but softly. 

Better while standing. Right side- 

Borax, Discharge of pus from the ears, with roaring and 
hardness of hearing in the left ear. 

Worse in the evening, from cold, and while lying down in bed. 



44 Surgical Diseases of the Ear. 

Better from pressure, and from warmth. Left side. 

Bryonia alba. Sensation as if the ears were obstructed ; hum- 
ming in the ears ; intolerance of noise. 

Worse in the evening, from motion, exertion of the body, and 
from heat. 

Better while lying on the painful side, and on getting warm in 
bed. Left side. 

Calcarea carb. Deafness, as if caused by obstruction of the 
ears ; frequent humming and rolling, or tinkling, singing, and 
music in the ears ; frequent throbbings, with heat, in the ears ; 
constant dryness of the ears, or else purulent discharge ; pressive 
headache in the forehead ; stitches or pulsations in the ears ; 
inflammation of the external and internal ear ; polypus of the ear ; 
hardness of hearing, especially after the suppression of intermit- 
tent fever by Quinine. 

Worse in the morning and in the evening; also, in the cold, and 
in wet weather. 

Better while and after lying down, and from rubbing. Left side ? 

Calcarea phos. Has been used for polypi in the ear. 

Capsicum an. Aching deep in the ear ; swelling behind the 
ear; painful to touch. 

Carbo veg. Every evening, heat and redness of the external 
ear ; deficiency of wax ; foetid suppuration of the inner ear ; pulsa- 
tion in the ears. 

Worse in the forenoon and in the morning; also, in the open 
air, from poultices or pressure. 

Better after lying down. Left side. 

Causticum. Sensation of obstruction in the ears, with rumbling, 
roaring and humming in the head ; loud vibrations of all sounds, 
even of the patient's own voice, in the ear ; discharge from the 
ears ; rheumatic pains in the ears and limbs ; extraordinary sensi- 
tiveness to cold wind ; spasmodic pain in the ear, as if the inner 
parts were pressed out ; painful swelling of the external ear. 

Worse in the evening ; also, in the open air. 

Better in bed, and from heat. Either side. 

Chamomilla. Otalgia, with stitches and tearing; discharge of 
thin pus from the ears ; sensitive hearing. 

Worse at night ; also, from cold, and when lying down. 

Better after perspiration. Right side ? • 

China Off. Humming in the ears, with hardness of hearing; 
stitches in the ears ; heat in the outer ear. 



Special Therapeutics. 45 

Worse at night ; also, from touching the parts softly. 

Better in the room. Either side. 

CiCllta virosa. Sore pain behind the ear, as after a blow ; 
haemorrhage from the ears; detonation in the right ear when 
swallowing; hardness of hearing; burning, suppuration on and 
around the ears. 

Worse in the afternoon ; also, from cold. 

Better while in bed, and from warmth. Right side ? 

CistllS canaden. Discharge from the ears of water and bad- 
smelling pus ; inner swelling of the ears, with discharge ; tetters 
on and around the ear, extending to the external meatus. 

Worse in the evening, at night, and in the morning ; also, from 
cold air, when lying down, and from motion, 

Better in the fresh air. 

CofTea Crilda. Music has a shrill sound to the ears ; sense of 
hearing more acute ; the pains are felt intensely, driving one to 
despair, with inclination to weep. 

Worse in the morning, and at night ; also, in the open air, and 
from cold. 

Better from cold water. Either side. 

Colchicum. Discharge from the ears, with tearing in the ears 
after measles ; stitches in the ears, in the evening ; dryness of the 
ears. 

Worse in the evening and at night ; also while walking, and on 
being touched. 

Better while reposing, or sitting. Right side ? 

Cotlium mac. Stitches in and around the ear; accumulation 
of ear wax, looking like decayed paper, and mixed with purulent 
mucus ; blood-red cerumen ; roaring and humming in both 
ears. 

Dulcamara. Dragging pain in the ear, with nausea; stitches in 
the ears ; tingling in the ears ; pricking in the ears ; complaints 
brought on by taking cold or getting wet. 

Worse in the evening ; also, when at rest, from cold air, and in 
wet weather. 

Better from running about, and from warmth. Left side 

Graphites. Great dryness in the ears, or purulent otorrhcea; 
difficulty of hearing, which is sometimes removed from the motion 
of a carriage, or cars ; singing, whistling and tinkling, or humming 
and thundering in the ears, especially at night ; sensation as if the 



46 Surgical Diseases of the har. 

air penetrated to the eustachian tube ; herpes and scabs about the 
ears, and on different parts of the body. 

Worse at night ; also, from cold. 

Better on getting warm. Left side. 

Hepar Slilph. Darting pain in the ears; itching of the external 
ear ; discharge of fcetid pus from the ear ; scurfy eruption on and 
behind the ear ; whizzing and throbbing in the ears, with hardness 
of hearing; detonation in the ear when blowing the nose. 

Worse at night ; also, from cold, when lying on the painful side, 
and when touching the parts. 

Better from warmth. Right side. 

HyOSCyamilS nig. Hard hearing, as if stupefied; buzzing in 
the ears. 

Worse in the evening ; also from cold, and after lying down. 

Better on rising, and from warmth. Right side ? 

Kali Carb. Stitches in the ears, from within to without ; inflam- 
mation and suppuration of the ear ; itching and tickling in the 
ears ; redness, heat and violent itching of the external ear ; crack- 
ing in the ears ; discharge of yellow liquid cerumen or pus from 
the ears ; inflammation and hard swelling of the parotid glands ; 
dullness of the hearing ; singing, whizzing and roaring in the ears. 

Worse in the morning ; also, in the room, after walking, from 
cold air, and when lying on the side. 

Better on getting warm, and on walking in the open air. Right 
side. 

KreOSOte. Stitches in the ears ; itching in the ears and the soles 
of the feet ; humid herpes on the ear, with swelling of the cervical 
glands, and livid, gray complexion ; inflammation of the left outer 
ear, red, hot, swollen ; burning proceeding from a pimple in the 
concha, with stiffness and pain in the left side of the neck, shoulder 
and arm. 

Worse in the morning ; also, in the open air, and on moving. 

Better from warmth. 

Lachesis. Dryness, with want of wax, and hardness of hear- 
ing ; cerumen too hard and pale, or white, and like pus ; painful 
pulsations, cracking or humming, rolling or drumming noise in the 
ear, with loud reverberations of all sounds. 

Worse in the afternoon ; also, while lying down. 

Better from moving. Right side ? 

Ledum palustre. Roaring in the ears, as if from wind; ringing 



Special Therapeutics. 47 

and whizzing in the ears ; hardness of hearing, as if the ear were 
obstructed by cotton ; confusion and giddiness of the head, on the 
side affected ; sensation of torpor of the integuments, especially 
after suppressed discharge from the ear, nose or eyes. 

Worse in the evening and at night ; also, from heat. 

Better from cold. Right side. 

Leptandria. Jahr recommends it, but I can find no symptoms 
that are at all reliable. 

LyCO podium. Over-sensitiveness of hearing; music and sounds 
affect the ear painfully ; roaring, humming and whizzing in the 
ears ; sensation as if hot blood rushes into the ears ; congestion of 
blood to the ears ; humid, suppurating scurfs on and behind the 
ears ; ulceration and running of pus from the ears ; hardness of" 
hearing, the ears being closed, with whizzing singing in the ears, 
as from boiling water. 

Worse in the evening, and at night ; also, while lying down and 
when at rest. 

Better from cold, and in the open air. Right side. 

Manganum. Pains extend to and concentrate in the ear from 
other parts ; stitches in the ear when talking, laughing, swallowing 
and walking; hardness of hearing, as if the ears were closed up; 
they open on blowing the nose, and are affected by the change of 
weather ; cracking in the ears on blowing the nose, and on swal- 
lowing ; whizzing and rushing in the ear. 

Worse at night ; also, on stooping, and when the parts are touched. 

Better from pressure. Either side. 

MenyantheS, Stitches in the ears ; cracking in the ears when 
masticating; feeling of coldness in the ear; running of the ears 
after exanthemata. 

Worse in the evening ; also during rest and when lying 
down. 

Better from motion, and from pressure on the affected part. 
Either side. 

MercurillS. Inflammation of the internal and external ear, 
with stinging pain ; soreness of the internal ; fungus excresence in 
the ear ; discharge of pus from the ear, with ulceration of the 
external ear; pulsative roaring in the ears; hardness of hearing; 
all sounds vibrate loudly in the ears ; the ears feel obstructed, but 
open when swallowing or blowing the nose ; buzzing, roaring or 
ringing in the ears ; ears obstructed from enlarged tonsils. 



48 Surgical Diseases of the Ear. 

Worse in the evening and at night ; also, from the heat of the 
bed, during perspiration, and when exercising. 

Better when at rest, and when lying down. Left side. 

Mezereum. Deafness, and thickening of tympanum after sup- 
pressed eruptions of the scalp. 

Natrum mur. Stitches in the ears ; pulsation and beating in 
the ear ; swelling, burning and heat in the ears ; hardness of 
hearing; discharge of pus from the ears; humming, ringing and 
singing in the ears ; painful cracking in the ear when masticating ; 
itching behind the ears. 

Worse in the morning, and at night ; also from talking. 

Better after lying down, and when lying on the back. Either side. 

Nitric acid. Stitches in the ear; suppuration and discharge of 
pus from the ears ; hardness of hearing, especially from swelling 
of the tonsils from Mercury j cracking in the ears when masti- 
cating ; beating and humming in the ears ; echo in the ears of one's 
own speech ; caries of the mastoid process ; steatoma at the lobe. 

Worse in the evening and at night ; also, on awaking, and on 
touching the parts. 

Better while riding in a carriage, and on getting warm. Right 
side. 

NlJX Vomica, Otalgia, with tearing, stinging pains ; when he 
raises his face, tension in the ears ; painful, sharp shocks and 
stitches in the ears, especially in the morning, in bed ; pain in the 
ear on swallowing, as if it were pressed outward ; strong reverbe- 
rations of sound in the ears. 

Worse in the morning, and at night ; also, from a slight touch, 
and from motion. 

Better from strong pressure. Right side. 

Petroleum. Troublesome dryness of the internal ear, or dis- 
charge of blood or pus ; tinkling, or rolling and humming in the 
ears ; hardness of hearing ; humid soreness behind the ears. 

Worse in the morning and in the evening ; also, after a walk in 
the open air. 

Better from warmth. Right side ? 

Phosphorus. Hardness of hearing, especially of the human 
voice ; roaring before the ears ; reverberations of all sounds, but 
more particularly words in the ears. 

Worse in the evening, and at night ; also, from lying on the 
back or left side. 



Special Therapeutics. 49 

Better while lying on the right side, and from rubbing. Right 
side ? 

Pulsatilla. Otalgia, with darting, tearing pains ; inflammation ot 
the external and internal ear, with redness, heat, and swelling ; 
flow of mucus, or thick pus from the ear ; hardness of hearing, as 
if the ears were stopped up, especially from cold, from having the 
hair cut, or from suppressed measles ; hardened black cerumen ; 
humming and tingling in the ears. 

Worse in the evening, and at night ; also from warmth, and 
while lying on the left or painful side. 

Better from cold. Right side ? 

Silicea. Otalgia, with stitches out of the ears ; itching in the 
ears ; stoppage of the ears, which open at times with a loud 
report ; difficult hearing, especially of the human voice, and 
during the full moon ; over-sensitivness of the hearing to noise ; 
swelling of the external ear, with discharge of pus from the 
ear ; aches behind the ear ; increased secretion of very thin 
cerumen. 

Worse in the night, also from cold, from wet, and from external 
pressure. 

Better from warmth. Right side. 

Stannum. Ulceration in the ring-hole in the lobule ; screaming 
in the ears when blowing the nose. 

Worse in the evening, also when lying on the painless side, after 
moving, and from talking. 

Better when lying on the back. Left side ? 

Staphisagria, Hardness of hearing, with swelling of the 
tonsils, especially after the abuse of Mercury. 

Sulphur, Stinging in the left ear; wabbling in the ears, as if 
water was in them ; discharge of pus from the ears ; humming in 
the ears ; hardness of hearing ; over-sensitiveness of hearing ; 
itching of the external ear ; frequent closing up of the ears. 

Worse in the evening and at night ; also on getting warm in 
bed, from bodily exertion, when talking, on touching the parts, 
while at rest, and when swallowing food. 

Better during motion, from heat, and in dry weather. Right 
side ? 

Veratrum. Hardness of hearing, as if the ears were stopped 
up ; roaring in the ears, as if from wind ; aching in the meatus 
auditorius. 
4 



50 Surgical Diseases of the Eyes. 

Worse in the morning, also during perspiration, after drinking, 
and after sleep. 

Better after perspiration, and from warmth. Right side. 

The only operation is for polypi, and that need not detain us 
here. (See tumors). 



SURGICAL DISEASES OF THE EYES. 

Foreign Bodies in the Eye — Wounds of the Eye — 
Ophthalmia — Strabismus — Pterygium — Opacity of 
Cornea — Chemosis — QEdema of Lids — Fistula Lachry- 
malis — Cataract — Retinitis — Iritis — Malignant 
Diseases and Various Diseases. 

Here a word of explanation seems to be necessary. Every 
physician can readily see that it is almost impossible to treat at 
length the therapeutics of the eye, in such a work as this, for 
modern science has almost made ophthalmic practice a distinct 
profession. Of course the diseases mentioned in this place will 
only be those that are most frequently met with, and that we know 
are amenable to treatment. One thing must be remembered in 
this connection. The chief reason why we have not a more 
extensive literature on this subject is, that patients are unwilling 
to resort to a long course of treatment for cataract and other 
diseases, when so much is promised them by operation, and it is 
only occasionally that we can keep them under our treatment long 
enough for them to perceive improvement. Again, until recently, 
few of our physicians have devoted any special attention to the 
eye. 

Foreign Bodies in the Eye. 

Sand, ashes, wood, particles of percussion caps, and iron are 
the substances oftenest found in the eye, and, if allowed to remain, 
may occasion very serious mischief. In scrofulous or cachectic 
persons, the inflammation resulting may assume a very obstinate 



Wounds of the Eye. 51 

and serious form. If the particles penetrate the ball, cataract, 
iritis, opacity, irido-choriditis, and even pan-ophthalmia, may 
follow, dependent upon the extent of the injury, the structures 
implicated, and the character of the foreign body. The cornea is 
so thick, much more so than many would suppose, that pieces of 
steel from mill-picks or anvils, may be literally dissected out, and 
if the operation is carefully performed, and followed by the admin- 
istration of Aeon., but little scarring need be apprehended, and if 
the patient be young, and of good constitution, the opacity may 
entirely disappear. Ars. or Sulph., according to indications, will 
promptly relieve the irritation felt after the substance has been 
removed. If the body is on the inner surface of the lids, it must 
be wiped off with a soft substance, as a camel's-hair pencil, and not 
by subjecting the sensitive membrane to harsh rubbing with a 
coarse pocket-handkerchief. Use no local applications in this or 
any other ophthalmic affection, unless it be water, and then prefer 
hot to cold. 

Wounds of the Eye and Lids. 

Wounds of the cornea that are extensive enough to allow the 
aqueous humor to flow out, but do not displace the vitreous humor, 
nor injure the iris, or capsules of the lens, are not very serious; i.e., 
not as much as is generally supposed. Close the lids, keep them 
covered with a light bandage. Frequently Aeon., followed by 
Staph., will suffice, in nearly every case, to restore the cornea, and 
the aqueous humor will be found to be also reproduced. If the 
hyoloid membrane is ruptured so that a portion of the vitreous 
humor is displaced, there will certainly be iritis, and perhaps 
cataract. More care in the treatment is now required, as the 
displaced portion is very slowly, if ever, restored, and whatever 
remains in the anterior chamber has to undergo absorption, unless 
removed through the wound. Total rest of both eyes is indispen- 
sable, as the uninjured organ will generally suffer from sympathetic 
ophthalmia. Keep both eyes covered, and confine the patient to a 
darkened room. Aeon., Am., Ars. and Sulph., are the remedies 
generally indicated, and if iritis supervenes, Bry., Bell., Apis., 
Mere., Rhus, or Calc, may be called for. 

Wounds of the lids are serious on account of the disfigurement 
that may follow, and the alterations in the lachrymal canal. They 



52 Surgical Diseases of the Eyes. 

should be closed with fine wire sutures or hair-lip pins, and if the 
canal is involved, a fine silver wire had better be passed through it 
by way of the puncta. Wounds of the conjunctiva must be closed 
with fine wire, or the denuded sclerotic coat may suffer. If not 
closed, small tumor-like fungoids may spring up, as occasionally 
after strabismus operations, and be very annoying. Should this 
happen, the best way is to snip them off with sharp scissors. 

Ophthalmia. 

Ophthalmia is an inflammation of the eye ; when it involves the 
lids and conjunctiva, it is called conjunctivitis. The names given 
it do not indicate so much the peculiarities of the variety, as the 
cause. Thus it may be gonorrhceal, syphilitic, strumous, scor- 
butic or rheumatic. In general, the symptoms may be said to be 
injection of the conjunctiva, swelling of the lids, disordered vision, 
pain more or less severe in the head, purulent discharge and 
perhaps ulceration of the cornea. The symptoms vary according 
to circumstances, and are often found exceedingly intractable. 
Local applications, except water, are to be strictly forbidden ; and 
darkness, and perfect bodily rest, enjoined in the worst cases. 
Very many cases are seen that present peculiar difficulties, from 
the injurious effects from nitrate of silver and sugar of lead. 
Recent cases are very readily relieved if care be taken in the 
selection of a remedy. A cure may often be effected in from 12 
to 24 hours. The causes are manifold ; exposure to cold, irritating 
applications to the eye, inoculation from some specific virus, and a 
constitutional predisposition to purulent inflammation. 

Strabismus. 

Strabismus is an obliquity in the axis of the eye, caused by a 
shortening in one of the recti-muscles, either spasmodically, from 
disease or nervous shock, or existing so congenitally. It may be 
internal or external, single or double. In congenital cases, it will 
occasionally be found necessary to operate, but in those resulting 
from disease, it will scarcely ever be required. In congenital cases, 
treatment is sought to rectify the deformity, as vision will rarely be 
impaired ; but in the other variety, the obliquity must be overcome, 



Pterygium — Opacity — Chemosis, etc. 53 

or serious trouble may ensue. Some little tact is occasionally 
necessary to determine which eye is effected, and as it requires 
too much space to enter into it here, I refer the reader to Walton, 
or in our own school to Angell, or to the forthcoming work of 
Dr. Allen. 

Pterygium. 

Pterygium is a hypertrophied condition of the conjunctiva, 
assuming the form of a fly's wing, hence its name. It is usually 
seen in the inner angle of the eye, extending out to the corneal 
margin, and sometimes beyond. Occasionally you will find two 
or three in one eye, when they are apt to cover the whole cornea, 
in time, and of course destroy the sight. If the patient can be 
retained long enough, a cure may be accomplished by remedies, 
and if this is found impossible the operation usually employed is 
simple and efficacious. 

Opacity of the Cornea. 

The cornea frequently becomes opaque from infiltrations, con- 
sequent upon inflammation, or from injur)? - . When the opacity is 
caused by scalds or burns, the condition is hopeless. Ulceration 
frequently leaves small specks of opacity, which can be sometimes 
removed by medicine. Under all circumstances, however, these 
cases are very troublesome. 

Chemosis. 

Chemosis is only seen in connection with ophthalmia. It is a 
pufflness of the conjunctiva, which resembles a ring around the 
cornea, which latter appears to be sunk into the eye in conse- 
quence. Should remedies not act promptly, a small puncture may 
be made, which will answer the purpose temporarily, but it will 
soon fill up again. 

(Edema of the Eyelids. 

(Edema is almost a constant accompaniment of some form of 
ophthalmia, is sometimes present with other diseases, and does not 



54 Surgical Diseases of the Eyes. 

differ from oedema in other situations. Care must be taken, 
however, not to confound it with a collection of pus. 

Fistula Lachrymalis. 

The lachrymal canal may become narrowed by swelling of the 
lining membrane, or by the deposit from some inflammatory 
action. Caries of the bones of the nose very frequently produces 
this; the fluid being unable to pass through the duct, is collected 
at some point, usually just at the inner angle of the lower lid, pro- 
ducing considerable swelling, with an exudation from the canal 
of a few drops of pus on pressure. Should the calibre of the duct 
not be soon restored, this swelling gives way, and a fistula results. 
Of course the fistula cannot be cured as long as the duct is imper- 
vious, and hence you must not look for any sudden closure of it. 
After the swelling has commenced to discharge is the time you 
will most frequently see such cases, and it is advisable to make a 
thorough exploration of the canal before commencing treatment. 
Sometimes a calcareous body will be met by the probe, which is 
to be pushed out, and after the inflammation consequent upon the 
operation is subdued, the fistula will soon close. Under good 
treatment there is but little occasion to resort to the style to open 
the tube, and perhaps if called early enough, it may never be 
needed. 

Cataract. 

Cataract is an opacity of the crystalline lens, or of its capsule, 
or of both ; the former variety known as lenticular cataract, that 
of the capsule as the capsular variety, and the latter as capsulo- 
lenticular. This classification is not as valuable as is generally 
supposed, as they indicate merely progressive stages of the same 
disease. That is, in time a lenticular cataract will be a capsulo- 
lenticular one. We have a further division into the hard and soft, 
open to the same objection; as I believe nearly all cataracts com- 
mence as soft, and become hard in proportion to their duration. 
The only benefit to be derived from this last division, is in 
making choice of an operation ; most surgeons preferring needle 
operations in the soft variety, and extracting in the hard. The 
appearances, however, are striking in each variety. The soft 







Retinitis — - Iritis. 5 5 

cataract can hardly be distinguished, unless in a very good and 
favorably directed light. They have a bluish cloudy appearance, 
with whitish spots here and there. The hard kind have a brown- 
ish-yellow appearance, are very distinct, but have been confounded 
with glaucoma. They are more peculiar to old age, although in 
accordance with my views, it might better be said that cataract 
becomes hard quicker in old age than in youth. 

Capsular cataract is of a dull, chalky-white color; and in the 
intermediate stages, the lenticular variety is also white, but more 
glistening, and not such a decided white. You will find more 
trouble in keeping such cases under treatment than any others. 
Out of thirty, I have only treated to a conclusion three cases ; the 
rest I operated on, after as long a delay as possible. The causes 
are injury to the lens, long continued inflammation, or an heredit- 
ary predisposition. When from inflammation of the iris, you will 
generally find an adhesion of this membrane to the capsule, which 
will materially complicate an operation for extraction. Iritis is apt 
to follow any operation, but Aeon., or Bry., or Rhus, will generally 
control it. 

Retinitis. 

Inflammation of the retina is rarely seen occurring inde- 
pendently of ophthalmia. When it does, the most characteristic 
symptoms are deep-seated pain in the ball, intolerance of light, and 
confused sight ; sometimes the ball seems swollen, and protruding. 
The treatment must be prompt, or the sight will be lost. 

Iritis. 

Inflammation of the iris rarely occurs unconnected with 
ophthalmia, unless it be the result of injury, or a complication in 
some specific disease, as syphilis. Operations for cataract are 
frequently followed by iritis, more particularly in the case of 
needle operations. There is pain in the eye, more or less acute, 
change in the color of the iris, loss of mobility, the iris may be 
either dilated or contracted, oftener the latter, and is irregular in 
shape, with serrated edges, the points shooting out over the lens ; 
ordinarily there is also photophobia, conjunctivitis, and aberrations 
of sight. If allowed to continue long unchecked, suppuration 



56 Surgical Diseases of the Eyes. 

ensues, which may result in loss of the eye. Frequently there is 
considerable lymph poured out, which fills both chambers of the 
eye, looking as if the ball were filled with milk. Sympathetic 
inflammations of the sound eye are common, hence an additional 
reason for* dispatch, which is only to be assured by a careful 
selection of the remedy. 

Malignant Diseases. 

Cancer of the eye, and its appendages, does not differ materi- 
ally from cancer elsewhere ; but as the diagnosis in some respects 
is difficult, it will be well to enter into a somewhat lengthened 
description. I shall draw liberally from the work of Mr. Walton. 
The forms of cancer most frequently met with in this situation, 
may be set down in the order of their frequency, as follows : 
encephaloid, melanosis, epithelial, and scirrhous ; the colloid form 
has never been seen in the eye. The first variety is seen- at all 
ages, but most frequently in children, the others in middle life : 
old age being particularly obnoxious to scirrhous. 

Encephaloma : In the earlier stages of this disease there is a 
yellowish shining, and deep-seated reflection from the bottom of 
the eye, resembling the appearance of a cat's eye in the dark, or as 
if a piece of metal were lying there. The iris looks darker than 
the other, pupil sluggish, and dilated, and vision extinct ; there is 
some external inflammation at ' times, though not by any means 
constant. As the disease advances, this metallic appearance is seen 
to be caused by a tumor springing up from the back of the eyes, " of 
an irregular rounded form, generally divided superficially into two 
or three lobes, and traversed by one or two small blood-vessels, which 
ramify on its suface ; in color it varies from a deep orange hue to 
nearly white, the most usual, perhaps, being a bright canary color. 
This growth gradually increases in size, approaches the front of 
the eye, causing absorption of the vitreous humor, and presses upon 
the lens, which becomes opaque, and in most instances is ulti- 
mately absorbed." As the disease progresses, the distension of the 
coats of the eye by the pressure of the growing mass causes the most 
excruciating pain ; the cornea becomes very thin, and the second 
stage is completed by the rupture of some of the coats, and the 
external appearance of the tumor. It may break through posteriorly, 
through the cornea, or the anterior part of the sclerotica. When 



Ma ligna nt D is eases. 5 7 

appearing in the orbit posteriorly, the eye is displaced in almost 
any direction, and in time the growth appears around the edges of 
the orbit, and soons covers and obliterates the eye. In the last stage 
the condition as described by Walton is as follows : " On its first 
escape it is soft, and generally of a light red or yellowish color; 
this appearance, however, is rapidly changed as it increases in 
bulk ; the surface becomes irregular, and covered with ulcerations, 
which discharge profusely; large, livid, and fungoid granulations 
form, which bleed freely on the slightest touch ; interstitial hemor- 
rhage takes place, forming clots in the interior of the growth, 
while large masses are detached from its surface by sloughing, 
giving rise to fresh bleeding, in some instances so profuse as to 
prove the immediate cause of death. No diminution in the size of 
the tumor ensues on the separation of the sloughs ; on the contrary, 
the growth seems to take place with increased vigor, and is limited 
only by the length of time that the patient survives. * * * * 
The skin of the distended eyelids, and of the adjoining parts of the 
face, assumes a dark livid hue, and is traversed by large varicose 
veins; and the glands of the neck, and under the lower jaw, are 
enlarged, and, in exceptional cases, proceed to ulceration." Death 
is due to exhaustion, deposits in some of the viscera, or hemorrhage. 
It is the most formidable disease to treat that I have any knowl- 
edge of, and failure is oftener the result than success. 

Melanosis is very difficult to detect until the tumor is forced 
through the sclerotica. In the commencement there is loss of 
vision with no apparent morbid growth, nothing to distinguish it 
from amaurosis, although sometimes there can be seen a small 
slate-colored tumor deep in the eye. The tumor, when it has burst 
through the distended eye, is dark, almost black in color, and 
sloughs, and bleeds just as encephaloma does. The progress and 
termination are about identical, only differing in the size of the 
growth, which rarely, if ever, attains the size of the former. 

Scirrhous is rarely seen in the eye-ball, though deposits occur 
in its immediate neighborhood, e. g., in the orbit, and ultimately 
involve the eye, although the well-known resistance of cartilaginous 
structures to scirrhous infiltration, offers a long interval between the 
first appearance of the tumor, or of displacement of the eye, and 
the final involvement of the whole organ. The same applies to 
epithelioma. So much for cancer as connected with the eye; in 



58 Surgical Diseases of the Eyes 

other respects the symptoms are identical with those to be described 
in the Chapter on Tumors. 

Various Diseases. 

Of other diseases we can speak but briefly, making it more a 
dictionary than anything else. Thus Amaurosis is blindness, with 
no apparent structural change. Aneurisms, and Varix, differ in 
nothing from the same condition in other situations. The same is 
true of Caries of the orbit, and Abscess. Other diseases are of no 
interest in this connection, as it is extremely problematical whether 
they can be cured by medicine. Among these we may class 
Ectropium, and its opposites, Trichiasis, Ptosis, etc., notwithstand- 
ing we are told they are curable. I have tried frequently, and, at 
the best, have seen little more than a " slight improvement." Until 
we are more assured by success, I prefer to consider it doubtful. 

Treatment — In these diseases, above all others, -what is 
called " constitutional treatment " is the only course to pursue. 
Topical treatment is useless, and as those who practice it generally 
use crude medicines for that purpose, I have no hesitancy in saying 
it is also positively hurtful. While a strenuous advocate of the high 
attenuations, I deem it a matter for " private judgment " in gen- 
eral practice, merely suggesting their advantages, but in these cases, 
I deprecate the use of any other preparations. In acute cases, 
give a dose of the proper remedy once in two, three, or four hours, 
until an effect is produced, then cease for as long as improvement 
continues. In chronic cases, give a dose but once in five or seven 
days, until improvement commences, then discontinue the medi- 
cine as above. As said in another place, the difficulty experienced 
in keeping patients under our treatment in these diseases, has 
operated against our having as much clinical experience as the 
subject demands. This seems to make it incumbent upon each 
one of us to contribute whatever knowledge he may have, so that 
homoeopathic ophthalmology may occupy the same exalted position 
held by other departments of our art. 

The remedies most frequently called for, are arranged in the 
customary " Index " form, and whatever there may be of meagre- 
ness in the indications, is owing to the neglect of our school in 
working this field. I must again refer to Drs. Angell and Allen 
all who are desirous of a thorough knowledge of the subject. 



Special Therapeutics. 59 

Wounds of Eye: 

Conditions resulting from. — Aeon., Am., Ars., Sulph. 

Iritis from. — Apis, Bell., Bry., Cale., Mere., Puis., Rhus. 

Inflammation: 

Whole Eye. — Aeon., Ars., Croc., Merc., Puis., Sulph. 

Cornea. — Ars., Cale., Euph., Hep., Sulph. 

Sclerotica. — Merc, Sulph. 

Conjunctiva. — Ars., Bell., Puis., Merc, Sulph. 

Ophthalmia : 

Of the New Born. — Aeon., Cale, Dulc, Euph., Lye, Merc, 

Nit. ac, Rhus, Sulph. 

Chronic. — Ars., Cale, Euph., Sep., Sulph. 

Arthritic. — Aeon., Bell., Cale, Cocc, Coloc, Lye, Spig. 

Catarrhal. — Ars., Bell., Euph., Hep. s., Mere, Nux v., 

Puis. 

Gonorrhceal. — Aeon., Chin., Nit. ac, Puis., Apis, Sulph. 

Rheumatic. — Aeon., Bry., Euph., Merc, Puis., Rhus, Spig., 



Sulph., Verat. 

Scrofulous. — Bell., Cale, Hep., Graph., Merc. Nit. ac, 



Puis., Sulph. 
Strabismus. — Alumin., Bell., Hyos. 
Pterygium. — Zinc, Apis, Ars., Sulph., Rhatan. 
Cornea : 

Opacity of. — Apis, Cale, Euph., Nit. ac, Sulph. 

Spots on. — Euph., Nit. ac, Sulph. 

Thickening of. — Cale, Cann., Nit. ac. 

Staphyloma of. — Apis, Lye 

Ulceration of. — Aeon., Ars., Cale, Caust., Hep., Graph., 

Lye, Merc, Nit. ac, Sil., Sulph. 
Chemosis. — Apis, Ars., Bell., Nux v., Sulph. 
CEdema of Lids. — Apis, Ars., Bry., Merc, Rhus, Sulph. 
Obstruction of the Lachrymal Duct. — Aeon., Apis, Ars. % 

Bell., Cale, Euph., Sep., Sulph. 
Fistula Lacrymalis. — Sulph., Bell., Cale, Lye, Nat. m., Puis., 

Stan., Sil. 
Cataract. — Sulph., Cale, Cannab., Con., Euph., Lye, Magnes., 

Sarsap., Sil. 
Retinitis. — Aeon., Bell., Bry., Cale, Merc, Puis., Rhus, Sil., 

Sulph. 



60 Surgical Diseases of the Eyes. 

Iritis. — Aeon., Ars., Am., Bell., Bry., Cale., Con., Dulc., Euph., 

Merc, Nux v., Puis., Rhus, Sep., Sil., Sulph. 
Amaurosis. — Aur., Cale., Chin., Dros., Merc., Nat. m., Phos., 
Sep., Sil., Sulph. 

On page 77 of Hempel's edition of Jahr's "Forty Years' Prac- 
tice," he (Hempel) says: "In purulent ophthalmia of new-born 
infants it is absolutely necessary to apply a feeble solution of Nitrate 
of Silver." With the greatest respect for Dr. Hempel's learning, I 
must say here that I consider that he is in error. If Nitrate of Silver 
is not indicated homceopathically, a cure can not follow its use ; 
and if it is indicated, the potentized remedy will more speedily 
produce the desired effect. I have cured many a case with two 
doses of Aeon. 200, and never saw one yet when it was " abso- 
lutely necessary " to use a wash of this kind. 

Aconite nap. Eyes red and inflamed, with deep redness of the 
vessels ; intolerable pains ; acute ophthalmia ; profuse lachrymation ; 
frightful inflammation of eyes, with lachrymation ; transitory blind- 
ness in many cases ; heat and burning in eyes, with pressive and 
shooting pains, especially on moving the balls ; swelling of the 
eyes; dilated pupils; dryness ; heaviness and pressure of the upper 
eye-lids ; inflammatory swelling of the lids, especially in the morn- 
ing; eyes sparkling, convulsed, and prominent; look fixed; excess- 
ive photophobia ; or a strong desire for light ; black spots and mist 
before the eyes. 

Worse at night ; also from taking cold, wine, or heated food ; 
and from sun-light. 

Better when sitting. Left side. 

Alumina. Stitches in the eyes; congestions in; sensation of 
coldness in the eyes and lids ; swelling of the lids ; inclination to 
stare; squinting; spasmodic contraction of eyelids at night with 
violent pain on opening them ; dim-sightedness as from a mist, 
compelling him to rub the eyes ; lachrymation during the day, 
agglutination at night. 

Worse in the afternoon, and on alternate days; also when sitting 
in the room. 

Better from moderate exercise, and in the open air. Right side. 

Apis mel. Quivering and twitching of the left eyeball, especially 
at nights ; burning stinging in the right eye, commencing with a 
dull heaviness, causing flow of water; stinging, itching in the eyes, 
eyelids, and around the eye; slight agglutination of the eyes at 



Special Therapeutics, 61 

night, has to pick them open in the morning ; soreness, redness of 
the eyes and lids, secretion of mucus and agglutination of the lids, 
attended with nettle-rash over the surface ; eyelids erysipelatously 
inflamed; weak eyes for several days, with photophobia; cedema- 
tous swelling of the lids ; sensitive to light ; smoky opacity oi 
cornea, occasioning almost entire loss of sight ; redness and 
smarting of lids ; puffy swelling of the lids, and around the eyes, 
with sensation of burning, and stiffness of the integuments; acute 
pain in the eyeballs ; slight inflammation of the lachrymal sac ; 
conjunctivitis with burning pain, increased flow of tears, and 
sensitiveness to light. 

Worse at night ; also from heat. 

Better from cold. Left side principally. 

Argent nit. Itching and smarting of the canthi ; aching pain, 
deep in the eye, early in the morning; pressure in the eyes as if too 
full, heat and pain in the ball when moving or touching it ; mucus 
flocks, impeding sight ; redness of the eye, with feeling as if from a 
grain of sand; sees through a mist; swollen puncta; cluster of 
intensely red vessels extend from the inner canthus to cornea ; con- 
junctiva is puckered and interstitially distended; conjunctiva of 
lids (and eyes?) as red as blood; conjunctiva is swollen, red and 
congestive around the cornea towards the inner canthus ; letters 
become blurred, and sight vanishes when reading or writing ; fiery 
bodies and flashes before the eyes in the morning and in the 
dark ; a large part of the cornea is covered with a white, opaque, 
apparently dense, but not very deeply penetrating spot ; contraction 
of pupil. 

Worse in the evening ; also from heat. 

Better from cold open air. Left side? 

AmiCcl mon. Faint, dim eyes, without luster; contracted pupils, 
with cloudiness of the head ; slight protrusion of the right eye ; 
painful, dull, intermittent pressure in the margin of the left orbit ; 
eyes half closed ; ophthalmia from mechanical injuries ; obscuration 
of sight. 

Worse in the morning, evening, and at night ; also when moving, 
from touching, and cold. 

Better from warmth. 

Arsenicum alb. Pains in the eyes, which oblige him to lie 
down ; lacerating in the ; stinging-burning in the eyes ; burning in 
the; ophthalmia violent, with intense redness and conjunctivitis, 



62 Stcrgical Diseases of the Eyes. 

and dark redness and congestion of the vessels ; inflamed eyes from 
having stood in the water ; specks and ulcers on the cornea ; violent 
inflammatory swelling of the lids, with oedema; faint protruded 
staring eyes, without luster, and turned upward ; dryness of the 
lids, especially the edges, with pain on moving them, as if they 
rubbed the eye ; profuse lachrymation ; the tears are acid and 
corrosive ; nightly agglutination ; spasmodic closing of the eyes, 
especially when looking into the light ; photomania ; obstruction 
of sight. 

Worse in the early morning ; also from cold, lying on the painful 
side, and from sun-light. 

Better from warmth. Left side. 

Aurum met. Pressure in the eyes as from some foreign body ; 
tension in the eyes, with diminished sight; red swelling of lids in 
scrofulous persons, with styes ; distended, protruded eyes ; indistinct 
sight, as if black gauze were drawn over the eyes ; half sight as if 
the upper part of the eyes were covered with a dark body ; double 
sight ; fiery sparks before the eyes ; specks on the cornea. 

Worse in the morning ; also on getting cold, and while reposing. 

Better from warmth. Left side. 

Belladonna. Entropium? throbbing pain in lower lids, towards 
the inner canthus, the spot is swollen and inflamed ; after waking 
in the morning, the eyelids close again spontaneously; itching 
stitches in the inner canthi, which only go off while rubbing; inner 
canthi of the left side is very painful, even when lightly touched ; 
smarting in both eyes ; salty water continually runs from the eyes ; 
feeling of burning dryness in both eyes ; pain and burning in the 
eyes; photophobia, with spasmodic movements of the eyes, occa- 
sioned by the light; interstitial distension of the sclerotica; specks 
on, and thickening, and ulcers of, the cornea; haemorrhage and 
ecchymosis of the eye; stitches in the eye, from without inwards; 
tingling and pressure in the eyes, they feel as if full of sand ; pain 
in the orbits ; the eyes feel as if being torn out, (sometimes as if 
pressed in) ; lacerating in the eyes, extending from the inner can- 
thus; dilated immovable pupils, they remain dilated even when 
the light is held quite near; vision is at times extinct, at times 
only diminished, with enormously dilated pupils ; things look dim 
and black; cannot read anything printed ; dimness of sight, alter- 
nating with cramps of the hands and feet ; when reading the letters 
look blurred, and blue and gold colored ; ring around the light, of 



Special Therapeutics. 63 

several colors, more particularly red ; double sight ; inverted vision ; 
eyeballs turn convulsively in a circle ; spasm of eyes. 

Worse in the afternoon and at night ; also from softly touching 
them when walking in the wind, when looking at glistening 
objects, and from candle light. 

Better while lying down. Right side. 

Borax. Soreness in the external canthi; burning in the eyes ; 
the eyelashes turn themselves inwards into the eye, especially in 
external canthus, inflaming it. (?) Inflammation of the borders of 
the eyelids, in infants ; at night the eyes close with a hard, dry 
gum, which irritates the eyes, like sand. 

Bryonia alba. The eyes are painful when touching them; 
pressure in the eyes, as if pressed out of the head ; pressure in eyes 
as of sand or smoke, particularly early in the morning, on awaking; 
lancination in the eyes ; burning in the eyes, and in the edges of 
lids, with biting and itching; redness and inflammation of the lids, 
with swelling, pressure, heat, and nightly agglutination (particu- 
larly of upper lids) ; painful swelling of one eye, without redness, 
with discharge of pus, and dark-red puffed conjunctiva; furfur- 
aceous herpes on upper lip, with burning itching; frequent lachry- 
mation, particularly in the open air, and when the sun shines 
brightly, with dim vision ; obscuration of sight, or else flames 
before the eyes ; stitches in' the eyes; eye feels too large for the 
orbit, and painful on turning. 

Worse at night, and in the morning ; also from heat, in the open 
air, from motion, and from light of sun. 

Better on getting warm in bed, and when sitting quiet. Left 
side. 

Calcarea carb. Pain as if pressed in, in the eyes ; pressure in 
eyes in evening ; stitches in the eye and head (during menses) ; 
cutting in eyes and lids, when reading by candle-light ; itching in 
eyes in evening ; itching in canthi ; pain as from excoriation in the 
lower lid ; feeling of heat in the eyes, with heaviness in upper 
lids ; burning in the eyes when closing the lids ; swelling and 
redness of the lids, becoming agglutinated every night; in the day 
time eyes full of gum, with feeling of excoriation, heat and sore- 
ness, and lachrymation ; lachrymation when writing ; eyes look 
watery, and lids are agglutinated every morning ; slight twitching in 
upper eyelids, with feeling as if eyes were moving spontaneously; 
dilatation of pupils, a darkness or sense of blackness sometimes 



64 Surgical Diseases of the Eyes. 

shoots across the eye ; sensation as of feathers before the eyes ; 
sensation as of a gauze before the eyes, in inner canthi; dancing 
wavelets of light, or fiery sparks, before the eyes, on awaking 
early in the morning ; dimness of cornea ; bright light dazzles the 
eyes. 

Worse in the morning or evening ; also from light of any kind. 

Better from warmth. Right side. 

CaustiClim. Ophthalmia resulting from repelled cutaneous 
affections ; eyelids feel weak and tired, can hardly open them : 
warts about eyes, or on the lids ; burning and itching of the eyes 
and eyelids ; acrid lachrymation ; painful stitches darting into the 
head from around the eyes ; momentary obscuration of sight when 
blowing the nose, or at other times ; dim-sightedness as from a 
mist or veil before the eyes, increased by rubbing them, and can 
not be rubbed away ; sight wavering and confused ; when the eyes 
become painful, colored wheels or green halo are seen about the 
light; movements before the eyes as of a swarm of insects, dimness 
of sight as from an incipient cataract, with periodical attacks of 
excruciating neuralgia, each seeming to increase the dimness of 
vision. 

Cannabis Sat. Cornea becomes opaque; specks and pellicle on 
the cornea ; sensation of spasmodic drawing in the eyes ; weakness 
of the eyes, and diminished vision ; pressure with lacerating in the 
upper eyelid. 

Worse in the forenoon, and at night; also during motion or 
exercise. 

Better from rest. Right side. 

China Off. Pressure in the eyes, as from drowsiness; pressure 
in the margin of the orbit, from without inwards ; pressure as from 
sand in the eye, when moving the ball ; itching in the lids ; redness 
of the eyes, with heat and burning with pressure ; lachrymation, 
with painful tingling on inner surface of lids ; yellowness of con- 
junctiva ; dim appearance of the cornea, and smoky feeling in the 
bottom of the eyes ; faint, protruded eyes ; the pupils incline to 
contract, or else they are very much dilated and insensible; flicker- 
ing before the eyes, and black motes ; dimness and weakness of 
sight ; when reading the letters look pale, with a white border, and 
confluent ; incipient amaurosis, particularly in drunkards (or after 
loss of animal fluids?); photophobia; sensitiveness to bright sun- 



Special Therapeutics. 65 

(pain in the eyes, worse from a slight touch, relieved by strong 
pressure. G.) 

Worse at night ; also from a light touch, and sunlight. 

Better in the room, and fronvstrong pressure. Left side. 

CoCClllllS ind. Pressure in both eyes, as if from dust ; dim 
sight ; flies and black spots before the eyes, moving as the eyes 
move, yet without impairing vision ; dilatation of pupils ; pain in 
the eyes, as if torn out of the head ; aching of the eyes, which 
can not be opened at night ; when reading a short time the print 
is all blurred ; obscure vision ; dryness of the eyelids. 

Worse at night ; also, after reading. 

Better in the house or room. 

ColOCynthis. Burning-cutting in the eye, also, in the lower lid 
of the right eye, when at rest ; cutting, as with knives, in the right 
eyeball, extending to the root of the nose ; discharge of an acrid 
fluid from the eyes ; sensitive pressure in the eye, especially when 
stooping. 

Worse in the afternoon and evening ; also, when bending over. 
Right side. 

Coilium mac. Itching and piercing pains in the canthi, or a 
smarting as if some acrid substance had been introduced into the 
eye. Pressure in the eyes, especially when reading; feeling of 
coldness in the eyes during a walk in the open air ; drawing pain 
and redness of the eyes ; heat and burning in eyes ; inflamed lids, 
with incipient styes in some places, and frequent winking ; yellow- 
ish color of the eyes ; tremulous look, as if the eyes were trembling ; 
dazzling of eyes from light of day ; photophobia, with pale redness 
of the eyeball, or partial congestion of the conjunctiva; obstruction 
of sight ; red appearance of objects ; dark points and colored streaks 
in the room ; short-sightedness increases ; aversion to light without 
inflammation of the eyes ; abundant acrid tears, overflowing the 
lid ; aching in the eyeballs, increased by reading in the evening, 
and by closing the eyes. 

Worse in the morning and at night ; also, from light, more par- 
ticularly of the sun. 

Better in the dark, and when moving about. Right side. 

DrOSera rot. Itching and agglutination of the eyelids ; pus- 
byopia, with weakness of the eyes, and sudden and repeated 
vibrations before the eyes ; gauze before the eyes, with blurred 
5 



66 Surgical Diseases of the Eyes. 

and pale appearance of the letters when reading ; eyes dazzled by 
light ; stitches in the eyes when stooping. 

Worse at night, toward morning ; also, from candle-light, or sun- 
light. 

Better when standing erect. Left side ? 

Dulcamara. Contractive pain in the margin of the orbits ; 
complaints of the eyes from being wet ; pressure in the eyes, made 
worse by reading; twitching of the eyelids in cold air; sparks 
before the eyes ; sees things as if through a gauze ; sensation as if 
fire were darting out of the eyes when walking in the sun or in a 
room. 

Worse in the evening; also, when at rest; from cold; in cold, 
damp weather. 

Better from warmth, and when in motion. 

Euphrasia Off. Smarting in the eyes as from sand; stinging in 
the eyes from bright light ; inflammation and ulceration of the 
margin of the eyelids ; inflamed cornea ; blueness and obscuration 
of, and pellicle over, the cornea ; swelling of the eyelids, particu- 
larly the lower; fine eruption around the eyes; burning and 
smarting lachrymation, particularly in the wind ; photophobia, and 
pain from looking at the light ; gum in the canthi ; purulent, with 
nightly agglutination ; rheumatic ophthalmia, almost blinding him ; 
dryness and pressure in the eyes ; stitches in the eyes from a bright 
light ; acrid lachrymation, with mild coryza. 

Worse in the evening ; also, in the wind, in daylight, and the 
light of sun. 

Better from warmth ? Right side ? 

Graphites. Pressure in the lids, as from sand; pressure in the 
right eyebrow, extending through the whole eye ; violent stitch 
through the right eye ; smarting, with heat in the eyes ; coldness 
over the eyes ; redness of whites of eyes, with lachrymation and 
photophobia ; redness and painful inflammation of the lower eye- 
lid and internal canthi ; swelling of lids and lachrymal gland ; 
frequent lachrymation of the eyes, with pressure in them, and 
stinging; agglutination early in the morning; intolerance of light; 
light dazzles the eyes. 

Worse at night; also, from cold, and light, daylight particularly. 

Better from warmth. Right side ? 

Gelseminum, Eyes feel bruised ; great heaviness of the eyelids, 
can not keep them open; eyes much inflamed, and weak, with 



Special Therapeutics. 67 

great flow of tears ; pricking pains, extending into or from the ball 
and adjacent parts ; double vision, controllable by the strength of 
the will, or when looking sideways, not when looking straight 
forwards; distant objects look obscure (asthenopia); dimness of 
vision, like smoke before the eyes; aversion to light, more to 
candle-light. 

Hepar Slllph. Pressure in the eyes, especially when moving 
them ; pain in the eyes, violent, as if pulled out of the head ; dull 
stitch in the eye ; boring pain in the upper bones of the orbit ; 
redness, inflammation, and swelling of the upper eyelid, with 
aching and stinging ; erysipelatous inflammation of the eyes, with 
soreness and bruised pain of the lids on touching them; inflamma- 
tion of the meibomian glands ; suppuration ; styes ; little pimples 
surround the inflamed eye ; lachrymation ; specks and ulcers on 
cornea ; protruded eyes ; obscuration of sight when reading ; 
twinkling before the eyes ; eyes ache from the bright light of day 
when moving them ; spasmodically closed eyes at night ; objects 
appear red, after abuse of Mercury. 

Worse at night ; also, from cold, daylight, pressure, or on being 
touched. 

Better from warmth. Left side. 

Lycopodium. Pressure as from dust in the eyes; bruised pain 
in the eyes ; tensive pain in the left eye ; stitches in the eyes, without 
any redness ; itching in the canthi ; smarting, burning in eyes ; 
inflamed aching lids, with nightly agglutination in outer canthi; 
hordeolum ; purulent gum in eyes, with smarting pain ; mucus in 
eyes; dryness of eyes in the evening; dim, hot eyes; spasmodic 
twitching of lower lid ; sight weak ; black spots hover before the 
eyes at a short distance ; twinkling before the eyes when going to 
bed ; sparks before the eyes in the dark ; blackness before the 
eyes ; sensation of vibration before the eyes ; stitches and soreness 
in eyes when looking at light in the evening ; sight obscured, as 
if from feathers before the eyes ; half sight, perpendicular ; eyes 
wide open," fixed, and insensible to light. 

Worse in afternoon and evening; also, when lying down, from 
wet warmth, and from artificial light. 

Better from cold. Right side. 

Magnesia Carbon. Pressure around the-eyes towards evening; 
lacerating in the eyes, followed by lachrymation; burning and 
stinging in the eyes, which look injected; agglutinated lids early 



68 Surgical Diseases of the Eyes. 

in the morning ; obscuration of cornea ; mist before the eyes ; 
black motes before the eyes; swelling of the eyes; dryness of the 
eyes. 

Worse at night ; also, when at rest, and from light of day. 

Better during motion. Left side ? 

MerCUrillS SOL. Swelling of the eyelids ; they are covered on 
the edges with scurfs and ulcers ; much purulent matter under 
the lids, which pours out on opening them. Pressure in the eyes, 
as from sand ; stitches in the eyes ; cutting under the lid, as from 
a sharp body ; itching in the eyes ; heat in the eyes ; burning in 
the eyes ; inflammation of both eyes ; a number of red vessels 
become visible in the sclerotica; injection of outer canthus ; lach- 
rymation of both eyes in the morning ; considerable redness and 
swelling, with constrictive closing of the lids ; pustules on the con- 
junctiva ; ulcers on the cornea ; scurfs around the eyes ; eyes dim, 
without luster ; dilated pupils ; black points before the eyes ; com- 
plete vanishing of sight for five minutes ; mistiness before one or 
both eyes ; dim-sightedness ; illusions of sight ; pain in the eyes, 
intolerable, which is not relieved by either hot or cold applications, 
which, on the contrary, seem to increase the pain ; aversion to light, 
and to looking into the fire. 

Worse at night ; also from the heat of bed, heat in general, and 
from artificial light. 

Better from cold ? Right side. 

Natrum mur. Sensation as if sand were in the eyes ; pain as 
from excoriation in the eyes ; violent burning of the eyes in the 
evening ; boring pain in the eyes ; redness and inflammation of the 
white of the eyes, with sensation as if the balls were too large, and 
pressed ; ulceration and great redness of the lower lids ; lachryma- 
tion in the open air ; acrid tears in the eyes early in the morning, 
making the canthi red and sore ; viscous matter in the outer can- 
thus ; dry feeling in the eyes, as after long weeping ; spasmodic 
closing of the eyelids ; dimness and obscuration of sight ; dim 
sight in the morning; gauze before the eyes; letters and sewing 
stitches become blurred when looking at them ; objects are seen 
through feathers, particularly white objects ; vanishing of sight ; 
diplopia ; black points before the eyes, and streaks of light ; a small 
fiery point before the eyes, which remains wherever she looks ; 
sees a fiery zig-zag appearance around all things ; one half the 
object is visible, the other half dark. 



Special Therapeutics. 69 

Worse in the morning, and in the evening ; also, when stooping, 
walking, reading, writing. 

Better when at rest. Right side. 

Nitric acid. Pressure in the eyes, as if pressing on an ulcer; 
stitches in the eyes ; smarting sensation in the eyes ; burning in 
the eyes and left temple ; swelling of the lids ; suppuration of eyes ; 
dark spots on the cornea ; lachrymation ; paralysis of the upper lid ; 
difficult contraction of pupils; photophobia; obscuration of sight 
when reading; sight becomes dim, objects appearing dark; in the 
open air suddenly becomes as if blind deranged; gray spots before 
the eyes ; muscae-volitantes ; sparks before the eyes ; double vision. 

Worse in the evening, and at night ; also, when walking ; from 
the touch ; and from candle-light. 

Better from warmth ? Right side. 

NlIX Vomica. Nightly lacerating in the eye; pressure on the 
upper eyelids, especially early in the morning; pressure in the 
eyes on opening them and looking at the light; burning and 
twitching of the lids ; suppurating canthi ; painless ecchymosis in 
sclerotica ; exudation of blood from the eyes ; intolerance of the 
light of day early in the morning, with obscuration of sight; 
yellowness of the lower part of the eyeball ; streaks like lightning 
before the eyes ; burning and smarting in the eyes, as if from salt. 

Worse in the morning; also, from light of sun. 

Better from strong pressure. Left side. 

Phosphorus. Determination of blood to the eyes ; inflammation 
of eyes, with heat and pressure, as from a grain of sand ; inflamed 
red eye ; swelling of the lid, with itching and pressure ; tumor on 
the border of the orbit; agglutinated lids in morning, on awaking; 
secretion of gum during the day ; difficulty of opening the lids ; 
sees every thing as through a gauze; short-sighted; blackness 
before the eyes; darkness at candle-light; frequent attacks of 
sudden blindness in the day time, with sensation of a gray color 
hanging over the eyes ; black passing spots before the eyes ; halo 
around the candle ; pains in the bones of the orbit ; sight misty, 
dim. 

Worse in the evening, and at night ; also, in the open air, in the 
wind, and from candle-light. 

Better in the dark, and from cold. Right side. 

Pulsatilla. Pressure in the eyes, as if from sand, especially 
when reading; sticking in the eyes when shaking the head; 



Jo Surgical Diseases of the Eyes. 

pressure in eyes when looking at light; inflammation of the eyes; 
inflamed margin of lids, with swelling; inflamed meibomian 
glands ; swollen red lids ; styes ; obscured corner ; dry eyes ; 
lachrymation in open air, with dimness of sight ; dim sight, as if 
through mist ; dim sight, on getting warm from exercise ; fiery 
circles before the eyes, increasing in size towards noon, and going 
off in evening ; feeling as if sight darkened by some onhanging 
mucus, which has to be wiped away ; like a veil before the eyes. 

Worse in the evening; also, from warmth and light of sun. 

Better from cold, and rubbing the eyes. Left side. 

Ratanhia. Inflammation of the whites; dim-sightedness ; 
temporary relief from wiping eyes ; white specks before the eye, 
impeding sight ; pterygium crassum. 

Worse in the evening, by candle-light. 

Rhus tOX. Ball of the eye feels sore on turning it, or when 
pressing upon it ; pressure in the eyes, as if from dust ; burning 
of the eyes ; inflamed lids ; swelling of the lids ; lachrymation, 
with burning pain in the evening; lachrymation with cedematous 
swelling around the eyes; objects look pale; pain in the eyes pre- 
venting motion, yet better when the eyes are kept in motion (pain 
on beginning to move the eyes, going off by continued motion.) 

Worse in the morning ; also, from cold, cold wet, and from light 
in general. 

Better from warmth, and continued motion. Right side. 

Sarsaparilla. Continued burning in the eyelids, sometimes 
alternating with aching pain ; inflamed, dry eyelids ; lachrymation ; 
agglutination in the morning; dilated pupils; dim sight, as if 
seeing through a fog, or as if the eyes were covered with a gauze ; 
stitches in the eyes; pain in eyes from light of day; internal corners 
of the eyes are bloated, and are of a blue color ; white paper looks 
red in the evening. 

Worse in the afternoon ; also, from cold. 

Better from warmth. 

Sepia. Pain in the eyes, with headache, and heat in eyes; pain 
in eyelids on waking, as if too heavy ; itching of the lids ; pricking 
pain in both eyes in the evening; burning of eyes in morning; 
inflammation of eyes, with red sclerotica, and stinging and pres- 
sure ; swelling of eye, with headache on same side ; swelling of 
both eyes in the evening ; pustules on the cornea ; glassy appear- 
ance of the eyes; jerking and twitching of the lids, inability to 



Special Therapeutics. 71 

open the lids at night ; paralysis of the lids ; dimness of sight when 
writing ; sight impeded by a fiery zig-zag before the eyes ; a num- 
ber of black spots before the eyes, or white luminous vibrations, 
or sparks of fire, or gauze, or streaks of light ; yellowness of the 
sclerotica ; green halo around the light of the candle ; pustules on 
the cornea. 

Worse in the forenoon and evening; also, from light of day, and 
from mental exertion. 

Better from warmth, and after violent exercise. Left side. 

Silicea. Smarting or heat in the eyes ; red sclerotica, with 
aching pain ; redness of eyes, with biting in canthi ; ulcers on 
cornea ; twitching of eyelids ; sparks or black spots before the 
eyes; dazzled by light; objects look blurred; obscured sight, as 
if looking through a gray coat ; paroxysms of sudden blindness ; 
paleness of sight when reading; swelling of tear gland ; letters run 
together when reading. 

Worse in the night ; also, from light of day, in open air, from 
cold and from getting wet. 

Better from warmth. Right side. 

Spigelia anth. Nervous pain in the eyes; pain in and above 
the eyes, deep in the orbits ; pain of eyeballs during motion, as if 
too large ; intolerable pressure in both eyes, worse when turning 
them ; sticking in the right eye, especially during motion ; digging- 
sticking in eye ; sticking with boring, penetrating to the interior 
of the head ; tingling in the eyes ; inflamed and ulcerated margins 
of lids ; sclerotitis ; dim and faint eyes ; upper lids hang down as 
if paralyzed; sight indistinct, as if the eyes were full of water; 
flashes before the eyes ; weakness of the eyes, in whatever direction 
they are turned they remain ; farsightedness. 

Worse in the night ; also, from bending down ; the least move- 
ment ; on touching the eye, and from light in general. 

Better when lying down. Left side. 

Sulphur. Violent pressure on moving the eyes; bruised pain 
in the eye ; painful dryness of the eyeball ; feeling of heat in the 
eyes; sensation as if the eyes were full of blood; burning in eyes; 
burning in the interior of the eyelids, which are red and inflamed : 
swelling and inflammation of conjunctiva; swelling of lids, with 
interstitial distention ; tubercles in the lids ; a little white vesicle 
on the sclerotica close to the cornea; ulcerated margins of lids; 
obscured cornea; specks and ulcers on the cornea; dryness of 



72 Surgical Diseases of the Eyes 

eyes ; purulent mucus in eyes ; trembling of eyes ; optical illusion, 
as if the skin were yellow ; like gauze before the eyes ; halo 
around the candle. 

Worse in the evening; also, from light in general, particularly 
sunlight, from touching the eye, from water, and on getting warm 
in bed. 

Better from motion, heat, and in dry weather. Left side. 

Veratrum alb. Inflamed right eye; diplopia; hemeralopia, 
commencing at twilight ; pressing in eyes ; heat in the eyes ; eyes 
look yellow or blue ; blindness at night ; paralysis of lids ; tremb- 
ling of the upper lids. 

Worse in the morning ; also, during perspiration, after sleep, and 
the light of the sun. 

Better after perspiration. Right side. 

ZinCUITI met. Soreness in inner canthi; the upper lids are 
lame, and droop ; constant weariness of the eyes ; whirring mo- 
tions before the eyes ; yellow, blue, and green wheels before the 
eyes ; fiery balls hover before the eyes in large semi-circles ; when 
lifting up the eyes he sees luminous flakes ; pterygium. 

Worse in the evening ; also, in a warm room, and sunlight. 

Better in open air. 

The same difficulty experienced in writing the first part of this 
section exists here; if all the remedies were mentioned that have 
eye symptoms, the list would embrace the whole Materia Medica. 
Only those have been recorded, therefore, that are most commonly 
required, and the student of ophthalmology knows the task of 
selection is one of no little magnitude. 

Operations. 

The temptation is strong to devote more space to this division 
of our subject than heretofore, for two reasons : First. It is com- 
paratively but imperfectly understood ; and, second, to argue some 
of the propositions here laid down. Let me say here, however, 
that the apparent dogmatism is owing to want of space, and noth- 
ing is said that I am not prepared to maintain. 

Strabismus is relieved by a division of the rectus muscle con- 
tracted. Never fix the eye with a sharp hook ; raise a small fold 
of the conjunctiva with fine forceps, and make an incision only 



Special Therapeutics. 73 

large enough for the admission of the blunt hook freely, with 
which draw out the muscle and divide with scissors. Give Aeon., 
three or four doses, after the operation, and keep a light shade 
over the eye. If a fungous appear at the incision, snip it off with 
scissors. 

Pterygium, cut across at the middle, or nearer the apex than the 
base, and the same treatment pursued. Give Zinc, or Ratanhia, 
according to Hughes, a fair trial first. 

Staphyloma operations necessarily destroy the eye; seize the 
cornea with rat-toothed forceps, and remove the whole front of the 
ball by a rapid incision, extending four or five lines around the 
corneal margin. If the whole eye is removed there is not as good 
a stump left for an artificial eye. Dress lightly, and use Aeon. * 

In obstructed lachrymal duct, push a fine probe through the 
puncta, and if the obstruction is not overcome, take a small teno- 
tome, with a round shoulder, and push it through the skin into the 
nasal duct, and insert a style, which is to remain until the tears find 
a natural passage. 

Cataract may be removed by one of two kinds of operations, 
either the needle, or knife ; of the two, prefer the knife ; but if a 
needle operation seems to be called for, prefer one through the 
cornea, to one through the sclerotica and posterior chamber. 
Extraction may be practiced either by an inferior, oblique, or 
lateral section of the cornea ; the last, or a modification of it, is the 
best for obvious reasons. Couching is out of date, and reclination 
also ; laceration of the capsule, to produce absorption of the lens, 
is all that is attempted with the needle now. Soft cataract is 
oftener operated on in this way than the hard. My reasons for 
preferring extraction are as follows : 

1 st. More speedy results. 

2d. Less danger of destructive inflammations, and consequently, 

3rd. More certainty. 

♦Have lately restored good and almost perfect sight, by an operation for Staphyloma, 
removing the upper part of the cornea. 



74 Surgical Diseases of the Nose. 



SURGICAL DISEASES OF THE NOSE. 

EPISTAXIS — LIPOMA — VARIOUS NASAL DISEASES 

— DROPSY OF THE ANTRUM — SUPPURATION 

OF THE ANTRUM. 

Epistaxis. 

Epistaxis is a hemorrhage from the nose, and may be either 
active or passive ; traumatic, or from some other causes. Usually 
this hemorrhage is of trifling importance, but occasionally it is 
very severe, and may even result in death. In slight cases I let it 
alone, as it seems to be a natural process ; but in serious cases it 
must be arrested. If remedies fail, the posterior nares must be 
plugged ; unless due to the division of some artery by cancerous 
degeneration, or as the result of injury, the remedies will not 
usually fail. In all cases the recumbent posture, and warm water 
applications, will be valuable aids. 

Lipoma. 

Lipoma is a term ill-bestowed, as it is apt to be confounded with 
tumors of the encysted variety. In this instance it is a chronic 
hypertrophy of the structures of the tip of the nose, and appears as 
a large, reddish-blue, soft, tremulous mass. They may be of all 
shapes, and of almost any size, from a mere clubbing of the end 
of the nose, to a large pendulous tumor. As Erichsen says, the 
sebaceous glands and crypts appear to be the structures chiefly 
implicated. 

Various Nasal Diseases. 

Other diseases occurring in other situations may be met with 
as affecting the nose; as lupus and cancer, tumors, calculi, abscess 
of the frontal sinuses, inflammation and abscess of the nose. 



Various Nasal Diseases. 75 

Lupus and Cancer are frequently met with, and from the 
deformity they occasion, appear to be particularly destructive. The 
treatment does not vary from that for the same diseases in other 
locations. 

Tumors, of different construction, occasionally appear here, and 
from the fact of their usually being pendulous, and filling up the 
nostrils, the word polypi is used to designate them all. Several 
well-established cases are recorded where a perfect cure followed 
the persistent use of remedies. Absorption of the bones is not 
infrequent, and without the tumor being at all malignant, great 
destruction of the parts may ensue. 

Calculi, or Rhinoliies, are " found in the nasal fossa, where they 
simulate a foreign body ; and here extraction may be practiced 
with a pair of forceps; sometimes these rhinolites are situated 
under the mucous membrane." 

Abscess of the Frontal Sinus may form with much pain and 
expansion, and possibly caries of their anterior walls, attended by 
inflammations, and with danger of extending to the membranes ot 
the brain. 

Inflammation of the Nose, or rather of the mucous membrane, 
often occurs. In the case of strumous young people, it may become 
chronic. Usually the membrane covering the turbinated bone is 
affected, and becomes much thickened, soft, and vascular, and is 
seen projecting like a broad fringe; in color it is usually bright 
red, and the surface is covered by mucus and pus. Wet weather 
increases the difficulty so much that serious obstruction of the 
breathing ensues, but at all times the voice is "nasal." 

Abscess of the Nose is a common disease, and an exceed- 
ingly painful one. The mucous membrane, or the septum, may 
be the seat, and upon the situation the gravity of the case depends. 
Necrosis of the nasal bones or cartilages frequently follows. When 
the abscess is followed by necrosis, depression of the bridge of the 
nose, foetid discharge, and similar symptoms, syphilis is probably 
the cause, and the disease then takes the name of ozozna, and is 
characterized by the additional condition of ulceration of the 
interior of the nose, forming hard crust. The deformity resulting 
often requires the aid of surgery to restore somewhat the sym- 
metry of the organ. 



76 Surgical Diseases of the Nose, 



Dropsy of the Antrum. 

Dropsy of the antrum is really but an accumulation of mucus 
here, owing to the canal leading into the nose being obstructed. 
As this opening is a little above the floor of the antrum, there is 
at all times a little mucus therein, but when, from some cause, 
the duct becomes closed, the accumulation may be sufficient to 
cause very much inconvenience. Then the expansion of the walls 
will cause the cheek to be more prominent, and the roof of the 
mouthy to bulge out. This condition may be suspected when the 
cheek is found to be semi-elastic, and on pressure gives rise to the 
"crackling or egg-shell noise." It is doubtful whether remedies 
will exert much influence on such a condition," but as they have 
been used, with alleged success, we should try them. 

Suppuration of the Antrum. 

Suppuration of the antrum may be due to some injury to the 
face, the irritation of a carious tooth, or other causes. Pus may 
form in the antrum, giving rise to pulsation, pain, and if not 
allowed to escape freely, may result in caries, or necrosis of the 
bones. It may find vent through the natural duct, or through the 
socket of a tooth, into the mouth. It is highly important that this 
discharge should be facilitated, for if, as in dropsy of this cavity, 
the canal leading to the nose is obstructed, the danger of caries or 
necrosis is greatly increased. 

Therapeutics. — These diseases will yield very readily to one 
of the following remedies, unless it be dropsy of the antrum, and 
that may prove just as tractable as the others. The remedies are : 
Aeon., Alum., Apis, Am., Ars., Aur., Baryta, Bell., Bry., Calc., 
Car bo v., Cham., Chin., Cera., Con., Crocus, Dulc., Erigeron, Ferr., 
Gran., Graph., Hep., Lach., Lye., Merc., Nit. ac, Nux vom., 
Phos., Puis., Rhus, Sabina, Sep., Secale, Sulph. They may be 
indexed as follows : 
Epistaxis: Erigeron can. 

From Congestion. — Aeon., Bell., Chin., Crocus, Con. 

During Coryza. — Ars., Puis. 

From Worms. — Cina., Merc., Gran. 

From loss of Fluids. — Chin., Secale, Carbo., Cina., Ferr, 



Special Therapeutics. 77 

Epistaxis : From Overheating — Aeon., Bell., Bry., Nux v. 

From Liquor. — Aeon., Bell., Bry., Nux v. 

From Physical Exertion. — Am., Bry., Calc., Puis., Rhus, 

Sulph. 

From Contusion. — Am. 

With Feeble Catamenia. — Puis., Seeale, Sep. 

With Profuse Catamenia. — Aeon., Calc., Croc, Sabina. 

— With Amenorrhcea. — Bry., Puis., Sep. 

Frequent, without apparent cause. — Calc,, Carbo v., Sep., 



Sil., Sulph. 
Inflammation of the Nose. — Apis., Ars., Baryta, Calc, Dulc, 

Hep., Lye, Merc, Puis., Sil., Sulph. 
Abscess of the Nose. — Apis, Ars., Bell., Calc, Hep., Lye, 

Merc, Puis., Rhus, Sil., Sulph., Aur., Con., Merc, Nit. ac, 

Sil. 
Lipoma: From Contusion. — Arn., Con., Rhus. 

From abuse of Mercury. — Aur., Bell., Hep., Sulph. 

From abuse of Liquors. — Ars., Calc, Nux v., Puls.,Sulph., 

Bell., Hep., Merc. 

From Scrofula. — Aur., Calc, Hep., Merc, Puis., Sulph., 



Bry., Lach. s Phos. 

Aconite nap. Bleeding of the nose, especially in plethoric 
persons ; vertigo when rising, with nausea, vanishing of the sight, 
and bleeding at the nose ; crampy sensation over the root of the 
nose ; it feels as if he would lose his senses. 

Worse in the evening, and at night ; also when rising, and in a 
warm room. 

Better in the open air, and when sitting still. 

Alumina. Soreness and scabs in the nose, with discharge of 
thick yellow mucus ; swelling and redness of the nose ; frequent 
attacks of coryza. 

Worse in the afternoon, and on alternate days ; while sitting in 
a room. 

Better during moderate exercise, and in the open air. 

Apis mel. Inflammation of the nose, externally and internally, 
with puffy, shining redness, and burning-stinging pain. 

Worse in the morning, evening, and at night; from heat, 
especially in the warm room. 

Better from cold water. 



78 Surgical Diseases of the Nose. 

Arnica montana. Tingling in the nose and bleeding; traumatic 
hemorrhage from the nose. 

Worse in the morning, evening, and at night; also on being 
touched, and from cold. 

Better on motion 

Arsenicum alb. Swelling of, and burning in the nose; ulcers 
in the nose ; cancer of the nose ; profuse, fluent coryza of sharp, 
burning, excoriating water, with hoarseness and sleeplessness; 
drawing stitches here and there in the face. 

Worse at night, also from cold 

Better from heat in general. 

Alirum fol. Caries of the nose; discharge of foetid pus from 
the nose ; foetid odor from the nose, very sensitive smell. 

Worse in the morning ; also from cold. 

Better from warmth. 

Baryta Carb. Scurf under the nose; troublesome dryness of 
the nose ; fluent coryza. 

Worse at night ; also when sitting. 

Better when walking in the open air. 

Belladonna. Inflammatory swelling and redness of the internal 
and external nose ; bleeding of the nose, with redness of the face ; 
over-sensitiveness of the sense of smell; putrid smell from the nose. 

Worse in the afternoon, and at night ; also from touching the 
parts but very softly. 

Better while lying down. 

Bryonia alba. Fullness and heaviness in the forehead, as if the 
brain were pressed out, with bleeding of the nose, and red, bloated 
face ; swelling of the nose, with very sore pain when touched ; 
bleeding of the nose, especially in the morning, with suppressed 
menstruation. 

Worse in the evening; also from motion, and from heat. 

Better on getting warm, in bed. 

Calcarea Carb. Inflamed, swollen and red nose; dryness of 
the nose ; nostrils ulcerated and scabby ; bleeding of the nose in 
the morning ; polypus of the nose ; stench before the nose, like 
manure, gunpowder, or putrid eggs ; stench from the nose ; smell 
diminished. 

Worse in the morning, evening, and night ; also from cold. 

Better from warmth. 

Carbo Ve[|. Frequent and continuous bleeding from the nose, 



Special Therapeutics, 79 

especially in the morning, or after straining to stool, with paleness 
of the face before and afterwards ; the tip of the nose is red and 
scabby ; itching around the nostrils ; coryza, with hoarseness. 

Worse in the morning and forenoon ; also in the open air, and 
from pressure. 

Better after lying down. 

Chamomilla. Wrinkled skin on the nose, ulcerated nostrils; 
sensitive smell. 

Worse at night ; also from cold, when lying down. 

Better on rising. 

China Off. Redness and heat of the nose ; tearing in the dorsum 
of the nose ; frequent bleeding from the nose ; hemorrhage from 
the mouth and nose ; bleeding of the nose after blowing it ; dry 
coryza, with toothache and lachrymation ; headache from sup- 
pressed coryza. 

Worse at night ; also from touching the parts softly. 

Better in the room. 

Cina. Bleeding from the nose and from the mouth, with burn- 
ing in the nose ; disposition to bore in the nose ; sneezing violent, 
with stitches in the temples; stoppage of the nose in the evening; 
fluent coryza at noon ; the nose burns. 

Worse at night ; also from pressure. 

Better after lying down 

Conium mac. Excessively acute smell, purulent discharge from 
the nose ; frequent bleeding from the nose when sneezing ; cancer 
of the nose. 

Worse in the morning, and at night ; also when lying down. 

Better from motion. 

CrOCUS Sat. Discharge from one nostril at a time, of tenacious, 
thick, dark-black blood, stringy, with cold perspiration on the 
forehead. 

Worse in the morning. 

Better in the cool, open air. 

Dulcamara. Bleeding from the nose, the blood is bright red 
and very warm, accompanied with a pressure above the nose ; dry 
coryza, aggravated in cold air. 

Worse in the evening ; also in cold air, and in wet weather. 

Better when moving about. 

Erigeron Can. In cases of epistaxis, of almost any kind, this 
remedy has never but once failed me. I use the strong tincture, 



So Surgical Diseases of the Nose. 

and administer it by olfaction. One or two smells of it has always 
sufficed. 

Ferrum met. Bleeding from the nose in the evening; the nose 
is continuously filled with clotted blood. 

Worse in the morning ; also when at rest. 

Better from s-low exercise. 

Granatlim. Tingling-itching in the nose; burning, heat, and 
dryness in the nostrils, or else accumulation of tenacious mucus ; 
alternation of fluent and dry coryza. 

Graphites. Painful dryness of the nose; bleeding at the nose; 
black, sweaty pores on the nose ; dry scurfs on the nose ; frequent 
discharge of thick, yellowish, foetid mucus from the nose ; coryza 
as soon as he becomes cold ; smell too sensitive ; cannot bear the 
smell of flowers. 

Worse at night ; also from cold. 

Better from warmth, and when getting warm in bed. 

Hepar Sulph. Inflammation, redness, and heat of the nose; the 
nose feels sore as if bruised; sore pain on the dorsum of the nose 
when touching it ; very sensitive smell ; coryza with inflammatory 
swelling of the nose, which feels sore as a boil. 

Worse at night; also from cold, from pressure, and on touching 
the nose. 

Better from warmth. 

Lachesis. Redness of the point of the nose, bleeding from the 
nose, of dark blood, and blowing of blood from the nose, especially 
in the morning ; discharge of blood and matter from the nose ; 
coryza, with discharge of thin water, and with red nostrils ; scabs 
in the nose. 

Worse in the evening; also after sleep, in the open air, and in 
the cold air. 

Better from warmth ? 

Lycopodium. Over-sensitiveness of the smell; bleeding from 
the nose, principally in the afternoon; scurf in the nose; nightly 
closing of the nostril by pus ; dryness of the nose ; obstruction 
about the root of the nose ; can only breathe with mouth open ; 
dryness of the posterior nares ; coryza with acrid discharge, making 
the upper lip sore ; violent coryza, with swelling of the nose ; fan- 
like motion of the nostrils; sneezing without coryza. 

Worse in the evening; also on lying down, and when at rest. 
Better from cold. 



Special Therapeutics. 81 

MerClirillS. Red, shining swelling of the nose, with itching; 
greenish foetid pus is discharged from the nose ; swelling of the 
nasal bones ; blackish nose ; scurfy nostrils, bleeding when they are 
cleansed ; bleeding of the nose during sleep, or when coughing ; 
profuse fluent coryza, with profuse discharge of watery corrosive 
mucus. 

Worse at night ; also from warmth, and from the heat of the bed. 

Better from cold ? 

Nitric acid. Stitch in the nose, as from splinters, when touch- 
ing it ; the tip of the nose is red, and covered with scurfy vesicles ; 
itching herpes on the wings of the nose ; bleeding of the nose, the 
blood is black and clotted ; disagreeable smell in the nose on inhal- 
ing air ; foetid yellow discharge from the nose ; foetid smell from the 
nose; condylomatous excrescence on the nose; soreness, burning 
and scurf in the nose ; unsuccessful attempt to sneeze ; the nose 
is dry, and stuffed up; complete obstruction of the nose, with 
dropping out of water ; dry coryza, with dryness of the throat and 
nose, the wings of the nose, inflamed and swollen ; fluent coryza, 
with obstruction of the nose, the mucus is only discharged through 
the posterior nares ; coryza, with dry cough, headache, hoarseness, 
and stitches in the throat. 

Worse in the evening, and at night ; also on touching the parts. 

Better on getting warm ? 

NlIX Vomica. Sensitiveness and inflammatory redness of the 
internal nose ; bleeding from the nose in the morning ; smell before 
the nose, like old cheese or brimstone ; coryza fluent during the 
day, and dry in the evening and at night ; dry coryza, with stop- 
page of the nose; acrid discharge from the obstructed nose. 

Worse in the morning and at night ; also from motion, and on 
being touched. 

Better from strong pressure. 

Phosphorus, Bleeding of the nose, during stool; blowing of 
blood from the nose; swelling and redness of the nose; painful 
dryness of the nose ; bad, foul smell from the nose ; over-sensitive- 
ness of smell ; readily-bleeding polypus of the nose ; profuse dis- 
charge of green or yellow mucus from the nose, without coryza ; 
freckles on the nose. 

Worse in the evening, and at night ; also from strong smells and 
when lying on the back. 

Better while lying on the right side. 
6 



82 Surgical Diseases of the Nose, 

Pulsatilla. The nose feels sore, internally and externally ; ulcer- 
ation of the external wing of the nose, emitting a watery humor; 
bleeding from the nose, of coagulated blood, with dry coryza; 
green and foetid discharge from the nose, like old catarrh ; smell 
before the nose, as from old catarrh ; coryza, with loss of smell and 
taste, or of long-standing, with a heavy yellowish-green discharge. 

Worse in the evening, and at night ; also in a warm room, and 
from warmth. 

Better in the open air, and from cold. 

Rhus tox. Redness of the tip of the nose, with soreness when 
touched; inflammation of the nose; the nose feels sore internally; 
bleeding of the nose at night, or when stooping, of coagulated 
blood; discharge of green offensive pus from the nose; puffiness 
of the nose; spasmodic sneezing; discharge of mucus from the 
nose, without coryza; dryness of the nose. 

Worse in the morning and at night ; also when at rest, when 
getting wet, and from cold. 

Better from warmth. 

Sabina. Has been recommended for epistaxis, but I can find 
no symptoms. 

Secale COr. Useful in hemorrhage from the nose, accompany- 
ing feeble catamenia. 

Sepia. Nose swollen and inflamed, especially on the tip ; tip 
of the nose scurfy ; ulcerated nostrils ; stoppage of the nose, dry 
coryza ; violent bleeding from the nose, and blowing of blood from 
the nose ; loss of smell, or foetid smell before the nose ; ozcena, with 
blowing of large lumps of yellow-green mucus, or yellow and 
green membranes, with blood from the nose. 

Worse in the forenoon, and in the evening ; also when at rest, 
and when bending down. 

Better from warm air. 

Sulphur, Blood comes from the nose whenever blowing it; 
bleeding of the nose, with vertigo, afterwards it feels sore when 
touched ; swelling and inflammation of the nose ; dry ulcers or 
scabs in the nose ; smell before the nose, as from an old catarrh ; 
freckles and black pores on the nose; herpes across the nose like a 
saddle ; burning coryza in the open air, obstruction of the nose in 
the room ; dryness of the nose. 

Worse in the evening, and at night ; also from bodily exertion, 
on touching the affected parts, and on getting warm in bed. 

Better from motion and from heat. 



Surgical Diseases of the Mouth. 83 



Operations. 

The operations are very simple. When pus forms in any of the 
cavities, perforate the bone with a small trocar, or a perforator 
made for the purpose, and give free exit to the pus. In epistaxis, 
when the hemorrhage cannot be controlled by remedies, the pos- 
terior nares are to be plugged with lint, or raw cotton. Bellocq's 
nasal sound and canula is the instrument to be used. When not at 
hand, I have often succeeded by introducing a piece of lint wet 
with the tincture of Erigeron into the nostril, and pushing it up 
and back, as far as is required, with a probe. 



SURGICAL DISEASES OF THE MOUTH. 



GLOSSITIS — PROLAPSUS OF THE TONGUE — ABSCESS 
OF THE TONGUE — RANULA — VARIOUS DISEASES 
OF THE TONGUE — ABSCESS OF THE GUMS — 
ULCERATION OF THE GUMS— EPULIS. 



Glossitis. 

Glossitis is an inflammation of the tongue, being the result, 
in general, of mercurialization. The tongue becomes enormously 
swollen, enlarged by the infiltration of serum; the increase in 
size, in some cases, having been known to threaten death by suffo- 
cation. The accompanying symptoms are, profuse salivation, ina- 
bility to swallow, or even speak, with the organ hanging out of the 
mouth, as in prolapsus. The difference is this, in glossitis there is 
a comparatively sudden invasion, whilst the latter is gradual. Our 
remedies, particularly Apis, act like magic in these cases, and the 
harsh allopathic procedure of slitting the tongue is seldom if ever 
called for. 



84 Surgical Diseases of the Mouth. 

Prolapsus of the Tongue. 

This is a condition in which the tongue hangs out of the mouth 
permanently. The patient has no power to retain it in the mouth 
any length of time. Prolapsus may be congenital, or acquired. 
The teeth, and even the jaws, are frequently pushed forward, the 
edges of the teeth meeting at an angle very similar to that noticed 
in the horse. Should this condition be allowed to remain unim- 
proved, the jaw will be permanently distorted. There are cases of 
evident hypertrophy of the whole organ, but the fault usually 
seems to lie in a want of power in the retractor muscles. The 
tongue is of a dark or purplish color, dry, much swollen, and there 
is a constant dribbling of saliva. I am not certain that this is a 
disease (if such it may be called) that is curable by medicines 
alone, but think operative measures will have to be conjoined with 
the other treatment. Still, it being a case in which there is no 
great urgency, time enough may be taken to test the remedies. 
This is one of those diseases which are of so rare occurrence, and 
the results of which are so very unsatisfactory, partly from the fact 
of but few being willing to give time enough to properly test the 
matter, that we know but little about the effects of remedies. We 
have to reason by analogy, and such reasoning in medicine is far 
from being reliable. I am not cognizant of a single case having 
been reported where a perfect cure followed the use of remedies. 

Abscess of the Tongue. 

This is also a very rare disease, and is not easily diagnosed when 
seen. Like all other similar diseases, the pus must be evacuated at 
once. Erichsen speaks of a case in which " there was an elastic 
fluctuating tumor of slow growth, about the size of a small plum, 
situated deeply in the center of the tongue." I never saw a case, 
but have been informed that as the tongue is not discolored it is not 
at all easy to tell whether it be an abscess or a tumor from some 
other cause. Dr. T. C. Duncan had a case of abscess of the 
tongue. The abscess was situated in the center of the tongue. 
It was about the size of a large pea and presented a red base ; 
cause, a cold ; remedy, Hepar. 



Ranula. — Various Diseases. 85 



Ranula. 

Ranula is a most interesting form of tumor, found under the 
tongue, to one side of the frenum. There are two varieties, first, 
a cyst, containing a fluid, and often as large as a walnut. The fluid 
is serous and of a glairy nature ; the walls of the cyst are very thin, 
almost transparent, and small vessels can be distinctly seen rami- 
fying on the surface. Many consider this a simple dilatation ot 
Wharton's duct, but that is not the general belief. Some patholo- 
gists, among them Paget, think many of these ranulae, " are proba- 
bly formed by dilatation of the sub-maxillary duct, obstructed by 
calculi or otherwise ; others by abnormal development of distinct 
cysts, or possibly of bursae between the muscles of the tongue." 
The second form is that of a true encysted tumor, the contents ot 
more or less consistency, and walls firmly adherent to the adjacent 
parts. 

Various Diseases. 

Tumors of all varieties are found in this situation, but do not 
need any special mention ; they should be treated according to 
the indications. 

Fissures or cracks in the tongue are found on the sides of the 
organ, and are usually dependent upon the irritation caused by the 
root of a molar tooth ; at other times they are the product of dys- 
pepsia, syphilis, etc. In cases where the general health is low, or 
the system is tainted with syphilis, struma, or scorbutis, these cracks 
are converted into large and foul ulcers, which extend rapidly, 
attended by offensive breath, and constant flow of offensive saliva; 
in fact, they are true phagedena. The surrounding parts of the 
organ are swollen and puny, and of a dusky-red color. Death 
frequently results from the excessive discharge, and the inability to 
take food, though in many cases rupture of the artery is the cause. 

I11 Psoriasis the tongue becomes shriveled and dry, much indu- 
rated, with the surface covered with cracks ; with patches, also, on 
the surface, of a dirty-white color, irregular in size and shape, vary- 
ing from an inch in diameter to the size of a pea. This condition 
is sometimes met as a manifestation of secondary syphilis, and 
certainly, to the eye, looks as much like a purely local disease as 



86 Surgical Diseases of the Mouth, 

such a thing can be. Another syphilitic condition is one that has 
not been named, to my knowledge, and is described by Erichsen 
in the following manner : " A glazed and warty appearance, as if 
covered with a layer of boiled sago, the mucous membrane being 
cedematous, elevated, and papillated, yet at the same time glassy 
and semi-transparent, and without induration." 

Syphilitic tubercle is an indurated and irregularly circumscribed 
tumor, situated deep in the substance of the tongue, usually near 
the center of the tip, and feels round to the touch. The integu- 
mentary cover of the tumor is of a coppery or dusky-red color, 
surrounded by cracks, but it does not ulcerate, discharge, or destroy 
the organ. 

Cancel- of the tongue so closely resembles some of the syphilitic 
affections of this organ that great care must be exercised in forming 
a diagnosis. One thing worth remembering is, that the syphilitic 
tubercle differs from the cancerous in being situated deeply in the 
substance of the part, while the latter is more superficial and is 
found about the edges and tip. (See Ulcers.) 

Ulcers. — There are the phagedenic, the syphilitic, and the can- 
cerous, and may be distinguished by attention to the following 
signs : Phagedenic, or sloughing, rapid progress, eroding action, 
and no induration at the base. Syphilitic, indurated base, elon- 
gated, or irregular in shape, and does not rapidly extend. Cancer- 
ous ulcers are, circular shape, " eroded edges," and spread rapidly. 

These are the main characteristics. The microscope should not 
be neglected, however, in examining sores in this region supposed 
to be cancerous. The cancerous ulcers produce all the dreaded 
symptoms and accompaniment of cancers elsewhere, and are very 
fatal. Joined to the proper cancerous disease is the inability to 
eat, which renders the condition of the patient more deplorable. 



Abscess of the Gums. 

Abscess of the Gums is caused by the roots of decayed teeth, 
cold, or some other inflammation, resulting in the formation of 
pus. It is of trifling moment, although it gives rise in many 
instances to considerable suffering. Remedies act very well. 
Evacuate the pus. 



Special Therapeutics. 87 



Ulceration of the Gums. 

Syphilis, scrofula, cancer, or any of the conditions operating to 
produce similar lesions in the mouth and on the tongue, may have 
the same effect here. 

Epulis. 

This is a tumor of a fibrous character springing from the perios- 
teum and edge of the alveolus, and implicating the osseous walls, 
growing up between and loosening the neighboring teeth, which it 
displaces and envelopes in its structure. It is most frequently met 
with in the lower jaw, and commonly about the molar teeth. This 
tumor is red, smooth, and lobulated, at first hard and semi-elastic, 
like the ordinary structure of the gum, but after a time softening 
by disintegration, and ulceration on the surface, with a purulent or 
sanious discharge ; it appears to be simply a circumscribed hyper- 
trophy of the gum. 

Malignant Epulis is soft, purplish, very vascular, grows rapidly, 
and is specially reproduced after removal. They are principally 
found in men advanced in life. 

Therapeutics. — The remedies in common use are : Aeon., 
Alum., Ambra, Apis, Arn., Ars., Bell., Bry., Cale., Carbo an., Carbo 
v., Caust., Clem., Dulc., Graph., Hep. s., Kali., Lach., Lye., Merc., 
Nat. mur., Nit. ac., Nux vom., Petrol., Phos., Rhus, Sep., Sil., 
Staph., Sulph., Sulph. ac., and Thuja. 

Tongue: Prolapsus of. — Ars., Caust., Calc, Dulc, Euphr., 
Graph., Hep., Lach., Nux, Sulph. 

Glossitis. — Aeon., Apis, Am., Ars., Bell., Lach., Merc. 

Abscess. — Apis, Ars., Calc, Hep., Merc 

Psoriasis. — Bry., Calc, Dulc, Led., Lye, Sep., Sulph. 

Fissures. — Alum., Calc, Hep., Lye, Merc, Petrol., Rhus, 

Sulph. 

Syphilitic tubercle. — Apis, Ars., Calc, Hep. s., Merc, Nit. 

ac, Rhus, Sil., Sulph., Thuja. 

Ranula. — Ambra, Calc, Merc, Thuja. 

Cancer, open. — Ars., Sil., Sulph., Bell., Calc, Hep., Lach., 

Merc, Nit. ac, Sep., Staph., Thuja. 

Induration. — Bell., Sep., Sil., Carbo an., Carbo 



veg., Nux v., Phos., Staph., Sulph. 



88 Surgical Diseases of the Mouth. 

Gums : Abscess of. — Calc, Caust., Si/., Staph., Sulph., Nat. tnur. 

Ulceration of. — Alum., Carbo v., Kali, Lye, Merc, Nat. 

m., Staph., Sulph. ac. 
Epulis : Calc. c, Carbo v., Lach., Sil., Ars., Clem., Graph. Hep., 
Nit. ac, Phes., Sep., Staph., Sulph., Thuja. 

Aconite nap. Dryness of the mouth, and of the tongue ; prick- 
ing and burning in the tongue; tongue coated white; trembling 
and stammering speech ; taste bitter ; everything tastes so except 
water ; aversion to food ; burning, ungovernable thirst for beer. 

Worse at night ; also from cold, and after drinking. 

Better in the open air, and from warmth. Left side. 

Alumina. Pains in the jaws, with sensation as if the teeth were 
elongated ; ulceration at the root of every tooth ; bleeding of the 
gums, and swelling; dryness of the mouth in the morning, fol- 
lowed by increased secretion of saliva, with an astringent sensa- 
tion in the mouth, and a musty, or putrid smell ; constant secretion 
of saliva in the mouth ; tongue feels rough, and is coated white, 
but with a good taste ; or, yellowish-white coating, with a bitter 
taste. 

Worse in the afternoon; also when chewing, and when drinking 
cold water. Right side. 

Ambra gHsea. Bleeding of the gums, especially of the right 
lower jaw; the gums are painful and swollen ; foetid smell from the 
mouth ; smarting in the mouth, with sensation as if the parts were 
excoriated, and with inability to eat anything solid, on account of 
the pain ; vesicles in the mouth, with a burning pain ; insipid, 
rancid taste in the mouth. 

Worse in the morning, and in the evening; also on awakening, 
after having swallowed the food ; when talking, and from eating 
warm things. 

Better while eating, when swallowing, and from cold food. 
Either side. 

Apis mel. (Great thirst; drinks often, but little at a time, G.) 
Extreme sensation of rawness and scalding all around the tongue, 
as if it had been scalded, and small pimples on the edge; followed 
by rawness, burning, and blisters along the edge of the tongue, 
which are very painful, accompanied by stinging; dryness and 
heat in the mouth and throat, and feeling in the tongue as if it had 
been burnt. 



Special Therapeutics. 89 

Worse in the morning, and in the evening ; also from heat. 

Better from cold water. Left side. 

Arnica mon. Tingling in the gums as if they had gone to 
sleep ; during mastication the gums are painful, as if from subcu- 
taneous ulceration ; biting sensation in the tongue ; foetid breath 
from the mouth ; tongue coated white, but has a good taste and 
appetite. 

Worse in the morning, evening, and at night; also, on awaking, 
after drinking, on moving the tongue, from talking, on touching 
the tongue. 

Better from warmth. Either side. 

Arsenicum album. Gums bleed readily ; tongue bluish ; coated 
white ; tongue, red and dry, or brown, or blackish ; cracked and 
trembling tongue ; insensible tongue as if burnt, having no taste ; 
foetid smell from the mouth; great dryness of the mouth and 
tongue; frequently accompanied with a violent thirst, drinking 
often, but little at a time ; aphthae in the mouth. 

Worse in the morning, and at night ; also from cold. 

Better from warmth. Right side. 

Belladonna, Painful swelling of the right side of the gums, 
with fever and sensation of chilliness ; vesicles on the gums, pain- 
ful like burns ; the tongue is painful, especially to the touch ; it is 
red, hot, and dry, with red edges, and white in the middle ; cracked 
tongue, white-coated; feeling at the tip of the tongue as if it had a 
vesicle upon it, painfully burning, when touched; tremor of the 
tongue ; the tongue is covered with a quantity of yellowish- white, 
tough mucus. 

Worse in the afternoon, evening, and at night ; also, when 
drinking, when swallowing fluids, when talking, and from eating 
warm things. 

Better when lying down, and from cold food or drink. Left 
side. 

Bryonia alb. Gums painful, as if sore and raw; the gums are 
spongy ; tongue coated white or yellow ; dry tongue ; rough, dark- 
colored tongue ; burning vesicles on the border of the tongue ; flat, 
insipid, sweetish, or disgusting taste in the mouth ; putrid taste ; 
bitter taste even of the food; aversion to food, at other times 
excessive hunger. 

Worse in the evening, and at night; also on chewing; while 



90 Surgical Diseases of the Mouth. 

drinking, when swallowing the food, from talking, and when eat- 
ing or drinking warm things. 

Better from cold food or drink. Either side. 

Calcarea Carbonica. Swelling of the gums; swelling of the 
gums painful, and without toothache there is swelling of the cheek, 
which is painful to the touch ; pustules on the gums over one of 
the molar teeth ; bleeding of the gums ; knotty swelling of the 
right cheek in the mouth, with drawing and lacerating pain every 
evening; blisters in the mouth, which form ulcers; the tongue is 
painful on the border, and its under surface, especially when chew- 
ing, swallowing, and spitting; violent burning of the tongue and 
mouth ; thick, white coating of the tongue, with sensation as if it 
were without any skin, and sore ; swelling of one side of the 
tongue ; little blisters on the tongue, with burning pain, and heat 
in the mouth ; bad, sour taste in the mouth ; loss of appetite ; at 
times the hunger is ravenous. 

Worse in the morning, evening, and at night ; also, on awaking, 
and from talking. 

Better on lying on the painful side. Right side. 

CarbO animal. The gums are pale, and painful as if ulcerated ; 
the teeth are so loose that the softest food gives pain ; gums red 
and swollen, and very painful ; drawing pain in the gums ; bleed- 
ing of the gums; burning at the tip of the tongue, and roughness 
in the mouth ; mouth and tongue are immovable, with difficulty ; 
drawing and very low speech ; bitter or sour taste in the mouth ; 
thirst, with aversion to cold drinks ; no appetite. 

Worse in the evening, and at night ; also, in the open air, and 
when awaking. 

Better when lying down. Left side 

CarbO Veg. Bleeding of the gums when cleaning the teeth; 
the gums are painful, and sensitive when chewing; drawing pain 
in the gums ; heat in the gums ; soreness of the gums in the day 
time; pustules on the gums; the gums recede from the teeth; 
increased flow of saliva ; bitter mucus in the mouth, early in the 
morning. 

Worse in the morning, and in the forenoon; also, in the open 
air, on getting heated, from pressure, and from eating or drinking 
warm things. 

Better from cold food and drink. Right side. 



Special Therapeutics. 91 

CaUStiCUITI. The gums are painfully sensitive, without tooth- 
ache ; swelling and painfulness of the gums before and behind ; 
swelling of the left side of the gums, with great sensitiveness when 
eating, and a spasmodic pain in the evening; fistula dentalis; par- 
alysis of the tongue ; a good deal of mucous saliva accumulates in 
the mouth; accumulation of water in the mouth, having a rancid 
taste. 

Worse in the evening, and at night ; also, on awaking, and when 
lying on the painless side. 

Better from warmth. Left side. 

Clematis erecta. Jerking, shooting and drawing toothache in 
the left upper jaw, at times in one, at times in another tooth; the 
pain affects all the teeth, without one being able to point out the 
tooth affected; a decayed tooth pains, and feels longer than the 
others ; increased secretion of saliva ; small blisters on the tongue 
and in the throat, which soon become ulcers. 

Worse at night ; also, from contact. 

Better from cold water. Either side. 

Dulcamara. Gums loose and spongy; dry tongue; paralysis 
of the tongue; swelling of the tongue, with impeded speech and 
breathing; hunger, yet with an aversion to food; violent desire 
for cold drinks. 

Worse in the evening, and at night ; also, when lying down, 
and from talking. 

Better from warmth in general. Either side. 

Graphites. Sore pain in the gums; ulcerated pain in the gums; 
itching corrosion of the gums ; swelling of the gums, and dryness 
of the mouth; white tongue; burning vesicles on the lower sur- 
face, and tip of the tongue ; painful tubercles and vesicles on the 
back part of the tongue; unusual thirst; appetite is variable. 

Worse at night ; also, on getting heated, before falling asleep, 
on awaking, from talking, and from eating or drinking cold 
things. 

Better while lying down on the painless side, and from warm 
food or drink. Left side. 

Hepar SllSphur. The gums bleed readily ; jerking in the 
gums ; inflammation and swelling of the anterior and inner por- 
tions of the gums ; ulcer on the gums ; burning pain on the tip of 
the tongue ; putrid taste in the mouth ; canine hunger, 

Worse in the morning, forenoon, evening, and at night; also, 



q 2 Surgical Diseases of the Mouth. 

before falling asleep, on lying on the painful side, from pressure, 
when swallowing the food or saliva, and on being touched. 

Better from warmth. Left side. 

Kali Carbon. Painful inflammation of the anterior gums ; 
swelling and soreness of the gums ; swelling of the tongue ; pain- 
ful vesicles on the tongue and gums ; putrid, bitter, or sour taste in 
the mouth ; little appetite ; violent thirst. 

Worse in the morning, evening, and at night ; also before falling 
asleep, on awaking, and on getting heated ; from eating or drinking 
warm things. 

Better from cold food or drink. Left side. 

Lachesis. The gums are raw and sore ; readily bleeding gums ; 
swelling of the gums, with blue-redness and great sensitiveness ; 
thick, yellowish coating on the tongue ; black tongue ; tongue 
feels stiff, with difficulty of moving it when swallowing ; red, sore 
spots, rhagades, and large, red papillae on the tongue ; gangrene 
of the tongue ; inflammation of the tongue, with titillation, causing 
cough ; offensive, bad taste in the mouth ; bitter taste ; loss of 
appetite ; sometimes great hunger. 

Worse in the evening, and at night; also in the open air, and 
from pressure. 

Better while eating. Left side. 

LyCOpodilim. Heat and pain in the gums; swelling of the 
gums over the front teeth, with swelling of the upper lip ; numb- 
ness of the inner mouth and tongue ; tongue painful and swollen ; 
tubercles on the tongue ; ulcer under the tongue ; ulcer under the 
tongue from holding the tip of cigar there; bitter taste in the 
mouth ; absence of thirst ; great and excessive hunger ; sometimes 
no appetite ; aversion to solid food ; aversion to bread. 

Worse in the afternoon, evening, and at night ; also, on awaking, 
when lying on the painful side, from pressure, and when eating or 
drinking cold things. 

Better from warm food or drink. Left side. 

MerClirillS. The gums recede from the teeth ; the gums are 
sore and swollen ; ulcerated gums ; burning pain in the gums at 
night ; bleeding of the gums when touching them ; foetid smell 
from the mouth; the tongue is coated as with fur; brown or 
blackish tongue; swelling of the tongue; inflammatory hard swell- 
ing of the tongue ; ulcerated edges ; hollow, ulcerated tongue, with 
swelling; tongue feels as if burnt; bitter, putrid, salt, sweet, or 



Special Therapeutics. 93 

sour taste in the mouth ; excessive appetite and hunger ; loss of 
appetite ; thirst, violent and burning, day and night. 

Worse in the evening, and at night ; also from warmth, and in 
getting warm in bed, and when swallowing. 

Better from cold. Right side. 

NatrillTI mur. Extreme sensitiveness of the gums to cold and 
warm things; inflammation and swelling of the gums, with swell- 
ing of the cheek; painful swelling of the gums, readily bleeding; 
scorbutic, putrid inflammation of the gums; ulcer on the gums, 
painful day and night; vesicles on the tongue; painful burning 
and smarting of the gums when eating; swelling under the tongue, 
with a stinging pain ; chronic sensation as of hair on the tongue ; 
heavy tongue; loss of taste; bitter, putrid, or sour taste in the 
mouth ; excessive appetite ; constant thirst. 

Worse in the morning, forenoon, and at night ; also when eating, 
from chewing, and from pressure. 

Better while and after lying down. Right side. 

Nitric acid. Itching of the gums; white swollen gums; bleed- 
ing of the gums ; vesicles on the tongue, and edge of the tongue, 
with burning pain when touched ; sour, bitter, or sweet taste in the 
mouth; variable appetite. 

Worse (the whole day alike ; a little easier in the forenoon) ; also 
when lying on the painful side, from pressure, and from swallow- 
ing, particularly the food. 

Better when lying on the painless side. Either side. 

NlIX Vomica. Swelling of the gums; swelling of the gums 
with pain, and a throbbing sensation as if an ulcer would burst 
out ; putrid, bleeding, swelling of the gums ; tongue black and 
cracked, with bright red edges ; dry tongue ; white or brownish 
tongue ; tongue coated with white or yellow mucus ; painful vesi- 
cles on the tongue; sour, putrid, or bitter taste in the mouth; food 
has no taste ; hunger, yet aversion to food. 

Worse in the morning and at night ; also, in the open air, when 
lying on the painful side, when swallowing the food, and from 
eating or drinking cold things. 

Better when lying on the painless side, and from warm food or 
drink. Left side. 

Petroleum. Swelling of the gums, with stitching pain when 
touched ; vesicle on the gums ; tongue is dotted with yellow spots ; 
White-coated tongue; rawness of the tongue and palate; foetid 



94 Surgical Diseases of the Mouth. 

odor from the mouth ; slimy, flat, or putrid taste in the mouth ; 
hunger causing nausea. 

Worse in the morning and in the evening ; also in the open air, 
and when swallowing the food. 

Better from warmth in general. Right side. 

Phosphorus. Inflammation and soreness of the gums; ulcer 
on the gums, with swelling of the lip ; bleeding of the gums at 
the slightest touch ; swelling of the root of the tongue ; dry tongue ; 
white mucus on the tongue, with slimy mouth ; furred tongue ; a 
number of small, red, bleeding tips on the anterior surface of the 
tongue ; slimy taste in the mouth ; loss of taste ; hunger, particu- 
larly after a meal. 

Worse in the morning, evening, and at night ; also when chew- 
ing, while drinking, while lying on the painful side, from pressure 
when swallowing, and when eating or drinking warm things. 

Better in the open air, and from cold food or drink. Left side. 

RhllS tOX. Intolerable burning, sore pain in the gums~; accu- 
mulation of water in the mouth ; the tongue is not coated, but is 
very dry ; parched, red, or brown tongue ; nightly discharge of 
yellow or bloody saliva from the mouth ; mouth feels better all 
day : complete loss of appetite ; excessive hunger. 

Worse in the morning, evening, and at night ; • also when chew- 
ing, when lying on the painless side, when swallowing the food, 
and when eating or drinking cold things. 

Better from warm food or drink, and from warmth in general. 
Left side. 

Sepia. Drawing in the gums ; bloated, dark, red gums, with 
painful beating, as in incipient suppuration ; painful swelling of 
the gums ; swelling of the gums, with painful soreness ; sore, 
ulcerated gums ; sore pain in the tongue ; white tongue ; pain in 
the tongue, as if burnt ; absence of thirst ; no appetite ; everything 
tastes too salt ; ravenous hunger ; much thirst. 

Worse in the morning, forenoon, and evening ; also before fall- 
ing asleep, or chewing, while lying down on the painless side, 
from swallowing the food, and when talking. 

Better from cold water. Right side. 

Silicea. Painful sensitiveness of the gums to cold water; pain- 
ful inflammatory swelling of the gums; sore gums; the gums 
bleed readily; coated tongue; tongue coated with brown mucus; 



Special Therapeutics. 95 

numbness of the tongue ; bitter or acrid taste in the mouth ; loss 
of taste; not much hunger, but thirst. 

Worse in the forenoon, afternoon, evening, and at night ; also in 
the open air, when lying on the painful side, from pressure. 

Better when lying on the painless side, from warmth in general, 
and in the morning. Left side. 

Staphisacjria. Burning-swelling of the gums, with heat in the 
cheek ; gums pale, blanched, and ulcerated, or painful and swollen, 
with tendency to bleed ; fungus excrescences on the gums, and in 
the mouth ; ulcerations, or numerous vesicles in the mouth or on 
the tongue ; swelling of the glands of the neck, and of the follicles 
under the tongue ; extreme hunger, even when the stomach is full. 
Worse in the morning, forenoon, afternoon, and night ; also on 
awaking, on chewing, from pressure. 

Better when swallowing. Either side. 

Sulphur. Swelling of the gums, with throbbing pain: hard 
swelling of the gums, discharging pus and blood ; burning pain on 
the surface of the tongue; dry tongue in the morning; brown, 
parched and rough tongue ; cracked and vermillion tongue ; putrid 
or bitter taste in the mouth ; complete loss of appetite ; thirst. 

Worse in the evening, and at night ; also on falling asleep, when 
swallowing the food or saliva, on talking, and from eating or drink- 
ing cold things. 

Better from warm food or drink. Left side. 

Sulphuric acid. Ulcers on the gums: vesicles on the inner 
sides of the cheeks ; dry tongue ; hunger, but no appetite ; putrid, 
flat, or pappy taste in the mouth. 

Worse in the forenoon, afternoon, and at night; also in the 
open air. 

Better from heat. Either side. 

Thuja OCCi. Swollen and sore gums; darting through the 
gums of the posterior molar teeth ; sore feeling in the gums ; 
toothache, with a sort of hacking or sharp beating in the gums ; 
considerable swelling of the gums and tongue; the tip of the 
tongue is sore to the touch ; rough, scraping feeling on the surface 
of the tongue ; ranula, transparent, jelly-like, blue-red or grey ; 
desire for cold drink. 

Worse in the afternoon, evening, and at night ; also on chewing, 
on getting heated, and when swallowing the saliva. 

Better from rubbing, and from cold ? Either side. 



96 Surgical Diseases of the Mouth. 

Operations. 

The whole tongue, or a part, is sometimes removed for cancer, 
hypertrophy, or prolapsus, by excision, or ligature. If required to 
operate, use the knife in preference to anything else : it is more 
certain, and more under your control. Ranula is to be removed as 
other tumors. Epulis should be removed by operation as soon as 
you are satisfied that the remedies are futile. A portion of the jaw 
is to be removed with a saw, and the whole of the visible diseased 
part taken off. Leave enough of the alveolus at each end of the 
incision to support the teeth, and endeavor to leave enough of the 
jaw to preserve somewhat the shape. In children, the ecraseur, or 
any instrument that can be used to ensure as little hemorrhage as 
possible, should be used, as in their mouths it is a difficult matter 
to secure the vessels. 



Foreign Bodies in the Esophagus. 97 



SURGICAL DISEASES OF THE THROAT. 



Wounds of the Esophagus — Foreign Bodies in the Esoph- 
agus — Scalds of the Mouth and Pharynx — Injuries 
of the Air Passages — Foreign Bodies in the Air Pas- 
sages — Asphyxia 7- Various Diseases of the Pharynx 
— Cancrum Oris — Laryngitis — Stricture of Esoph- 
agus — Parotitis — Bronchocele — Enlarged Tonsils. 

Wounds of the Esophagus are not common, chiefly occurring 
in the case of suicides. Wounds of this canal are almost sure to 
be complicated with similar injury to the trachea and large vessels. 
When the carotids are wounded, of course there is but little chance 
for anything being done. The wound in the esophagus must be 
closed with wire stitches, and the external one kept open until the 
other has healed. Every effort must be made to prevent esoph- 
agitis ; inflammation will be readily excited, and, by inducing 
suppuration, prove fatal. 

Calendula™, given about four times a day internally, will, in 
most cases, prevent this ; but when the first symptoms of inflam- 
mation appear, administer Aconite™, in the same way. 

Foreign Bodies in the Esophagus. 

Foreign bodies, such as fish-bones, needles, etc., are quite com- 
monly met. The long esophageal forceps are generally sufficient 
to extract them, though it may be necessary to operate. This 
operation is one of great danger. The incision is made in the neck, 
to one side of the trachea, and between that and the large vessels 
of the neck. Never make the opening larger than is absolutely 
required to extract the substance. The same rules apply here for 
the prevention of esophagitis. For more particular treatment, see 
" Special Therapeutics of the Throat." „ 
7 



98 Surgical Diseases of the Throat. 



Scalds of the Throat. 

Scalds of the mouth and pharynx are often met with among 
children. The effects are severe ; oedema of the glottis, inflam- 
mation of the whole buccal cavity, and death from suffocation 
unless speedily relieved. More special treatment will be given 
further on. 

The best remedy I have ever tried is Urtica urens, but not used 
as Laurie recommends, in the form of tincture gargle. I use the 
6th, sometimes the 3d, in water, one dose about once an hour. 
Usually this remedy will suffice ; but if a decided improvement 
does not take place in six hours, something else is needed. If 
neither Apis™ nor Aeon, suffice, and Opium and Kreos. fail, the 
only thing remaining to be done is to perform tracheotomy. 
When there is loss of substance, Calendula is to be used; and 
when sloughs form, Arsen. or Lack. When the oedema of the 
glottis is so great that respiration is embarrassed, and this increases 
without any remedy making an impression, the operation is the 
only resort. Before doing so, however, by making incisions into 
this oedema, relief may be obtained. The remedies will act if you 
get the right one ; so try all palliative measures to give you more 
time, before resorting to the very dangerous operation of trache- 
otomy. 

Injuries of the Throat. 

The larynx and trachea are frequently injured. There may be 
wounds, dislocation of the cartilages, or concussion of the larynx. 
Wounds in this region are generally the result of suicidal attempts ; 
they are more of the lacerated than the contused variety. A spe- 
cies of bronchitis, or actual pneumonia is sometimes set up, and in 
connection with the wound makes a very bad complication. One 
of the most serious symptoms or conditions is the appearance of 
food, entering the mouth, being ejected from the wound. When 
the esophagus is uninjured this is owing to a paralysis of the glottis. 
The treatment is that for ordinary wounds. Prevent the too early 
closure of the wound, until at least there is no danger of a non- 
closure of the one in the trachea or larynx. Suicides usually cut 



Foreign Bodies in the Air Passages. 99 

too high, thereby escaping the carotids ; should these vessels be 
wounded, you will probably lose the patient unless you are right 
on the spot. Should there be much gaping of the wound, apply a 
firm bandage around the head, and another around the body ; by 
means of tapes passing from one to the other, the head may be 
fixed in such a manner that much of the strain will be taken off of 
the stitches. 

Remedies. — Aconite, Calendula, and the usual treatment in 
wounds. Light diet and perfect quiet are essential. 

It occasionally happens that a blow is received on the neck, 
which results in an actual dislocation of one or more of the rings 
of the trachea. The accident is rare, and is quite serious. Replace 
the ring, throwing the head well back during the manipulations. 
Arnica or Co?iium are the remedies to be used. Bronchitis or 
pneumonia may likewise result from this injury. 

Another rare and fatal accident is paralysis of the larynx from 
concussion. This usually proves fatal, and there is little opportu- 
nity or time to use remedies. Arnica and Conium are the ones to 
be borne in mind. 

Foreign Bodies in the Air Passages. 

These accidents are not common. The symptoms are usually 
feeling of suffocation, great distress, "difficulty of breathing, violent 
fits of spasmodic coughing, and not unfrequently vomiting. Unlike 
the same obstruction in the esophagus, it must never be pushed 
down, but must come out of the mouth, or through an opening in 
the trachea or larynx. If the body be small, and one that will 
readily be dissolved, no treatment may be required ; but if hard, 
and not soluble, it must be removed. The operation of trache- 
otomy is a serious one, but under homoeopathic after-treatment 
little need be dreaded. Some may ask, Why operate at all, when 
it sometimes happens that the foreign substance is expelled through 
the glottis? Although, as Erichsen says, the foreign body may 
make its exit through the opening at which it entered, yet there is 
only one chance in ten, that, without operation, it will come away 
at all ; but should the operation be performed, it is reduced to a 
certainty, almost, that it will be expelled through one opening or 
the other. Should the foreign body be engaged, in the rima glot- 



ioo Surgical Diseases of the Throat, 

tidis, the forceps may be able to bring it away. Should the opera- 
tion be unsuccessful as regards the involuntary expulsion, the 
forceps can reach the body through the artificial opening. 

Place the patient lying en the back, with a pillow under the 
shoulders, so that the head is thrown well back ; local anaesthesia 
to a moderate degree, with rhigolene, may be employed ; but I 
prefer no anaesthetics. Make the incision through the integument, 
carefully avoiding all vessels, veins and arteries, for there should 
be no bleeding. Therefore, use the fingers and handle of the knife 
as much as possible. When the trachea is reached, wait for all 
bleeding to stop ; if any vessels are wounded, tie them at once. 
When the hemorrhage has ceased, take a sharp hook and fix it 
firmly, with one motion, through the tissue between the rings. Then 
taking the knife by the blade with the finger and thumb, so that 
only about a quarter of an inch is exposed, divide three of the 
rings by cutting upwards. Relief will be instantaneous. Should 
the foreign body be small, and passing up and down the trachea, 
much inflammation may exist, and oedema of the glottis supervene. 
In those cases, leave the wound open until this condition is cured. 
In other cases, close it at once with sutures and strips, and use, as 
indicated, Staphisagria, Calendula, Aconite, etc. 



Asphyxia. 

Asphyxia is a condition of suspended life from any cause, and 
may result from exposure to cold, starvation, drowning, noxious 
gases, strangulation, or, may be that of the newly-born. 

Of the Newly Born. — Various methods of resuscitation have 
from time to time been published, but none of them have been so 
universally employed as that of Marshal Hall. Another con- 
venient method is to raise the child repeatedly and regularly from 
the supine to the sitting posture. 

From Noxious Gases. — Remove the body into a cool, fresh 
current of air; dash cold water frequently on the neck, face and 
breast ; and if the body be cold apply warmth, either by heated 
bricks, friction or mustard. Inflate the lungs by artificial respira- 
tion. After life has been restored, Opium or Aconite will be useful, 
as indicated. 

From Strangulation. — Hering says : '" Remove all tight cloth- 



Asphyxia. 101 

ing. Put the patient in a proper position, the head and neck rather 
high, the neck quite easy, not bent forward. Begin by rubbing 
gently but constantly with cloths; give one injection of a dozen or 
two globules, or a drop of Opium, dissolved in a half pint of water, 
and inject slowly; this may be repeated every quarter of an hour, 
whilst the ribs are being rubbed gently. Put warm clothes on ; 
hot stones wrapped in blankets between the thighs, to the feet, to 
the sides, neck and shoulders. If, in an hour, no change is pro- 
duced, take a bitter almond, pound it fine, mix it with a pint of 
water, put a few drops into the mouth, or into the nose, and use 
the rest as an injection." Other physicians add to this treatment, 
subsequent administration of Aconite, A?'nica, or Ruta. 

From Drowning. — Resort to Marshal Hall's ready method, 
familiar to all, as found in all "Visiting Lists." In connection 
Lachesis or Solanum mam., in the form of injection, and also on 
the tongue, have been recommended by Hering and Laurie. 
In two cases that I have had, both of these remedies were tried, 
and nothing for good or evil resulted, though they may be useful 
in the subsequent treatment. 

From Cold. — When an individual is found in a state of frost- 
bitten asphyxia, remove him, with great caution, to a place of 
shelter, or unheated apartment, protect him from the slightest 
draught. He should then be covered over with snow, to the 
height of several inches, the mouth and nostrils alone being left 
free. Put the patient in such a position that the melted snow will 
run off readily, and its place be supplied by fresh. When there is 
no snow, a cold bath, the temperature of which may be reduced 
by ice (or a bath of cold or salted water*) may be substituted, 
and the body immersed therein for a few minutes. When every 
part has lost its frozen rigidity, the patient is to be undressed by 
degrees, or the clothes cut off. As the muscular or soft parts 
become pliable, they may be rubbed with snow until they become 
red, or the body is to be rubbed perfectly dry (if snow is not to be 
had), placed in flannel, in a moderately warm room, and rubbed 
with the warm hands of several persons simultaneously. In the 
event of no signs of returning animation, small injections contain- 
ing Camphor may be administered every quarter of an hour. . s 
soon as any symptoms of approaching restoration become per- 

*Salted water or salted snow must be used with the greatest caution. 



102 Surgical Diseases of the Throat, 

ceptible, small injections of luke-warm black coffee (coffee without 
milk) may be thrown up ; and as soon as the patient is able to 
swallow, a little coffee may be given, in the quantity of a tea- 
spoonful at a time. Against the excessive pain which is generally 
experienced when life is restored, Carbo v. should be supplied in 
repeated doses, and if it fail to relieve the sufferings, Ars. may be 
given. — Laurie. 

There are some remedies in common use for these accidents, 
which alone are of no avail, but in connection with the mechanical 
operations mentioned above, are of great value. They may be 
given in any of the three forms usual, i. e., by the mouth, nose or 
rectum, and may be classed as follows : 

Asphyxia, from a Fall — Am., Con., 

from a Fall and Loss of Blood — Chin. 

from Strangulation — Opium. 

from Suffocation — Opium. 

from Noxious Gases — Aeon., Bell., Opium. 

from Drowning — Lack., Solan, mam. 

from Freezing — Aeon., Ars., Bry., Carbo v. 

from Lightning — Nux v. 

of New-born Infants — Chin., Opium, Tart. em. 

In addition to the remedies cited for Asphyxia from lightnings 
bury the patient in the earth, all but the face, towards the sun, and 
dash cold water over him. 



Various Diseases of the Pharynx. 

Inflammation of the Pharynx is often of an erysipelatous nature, 
and then, if not arrested, terminates in suppuration or gangrene. 
The mucous membrane becomes thickened and tumefied, and gives 
rise to many unpleasant symptoms. When gangrene or suppura- 
tion succeeds the inflammation, it is necessary to keep the part 
clean, and hence the use of #/zmedicated gargles is requisite. 

Abscess of the Pharynx : The posterior wall of the pharynx is 
often the seat of abscess, and the presence of a tumor increasing 
in size more or less rapidly, and evidently fluctuation on palpation, 
may nearly always be considered an abscess. If in no other situ- 
ation in the body, this one should always be opened. The neglect 



Carter um Oris. 103 

to do this may result in the pointing of the abscess almost any- 
where, as the pus burrows under the loose tissues in this part of 
the body to almost any extent. 

Tumors of the Pharynx are usually of two varieties — either 
cancer or polypi. They are both malignant, as the polypi in this 
situation is malignant in its cause and termination, if not cancerous 
in structure. However, the tr e cancer is the most common, so 
much so that many authors speak of them as being the only tumors 
in this situation. From the peculiar structure of this part of the 
body, these tumors grow with great rapidity, and unless very early 
removed cause death by suffocation, from the obstruction to the air 
passages. 



Cancrum Oris. 

Cancrum Oris is common to childhood, and is apt to occur 
about the period of the second dentition, or during convalescence 
from some of the eruptive fevers. 

When caused by foul air, living in damp cellars, or insufficient 
or bad food, the insides of the lips, cheeks, or sometimes the 
gums, are found to be dotted with small, foul, gray ulcers ; the 
gums are spongy ; foetid odor from the mouth, and many of the 
symptoms consequent upon salivation. This constitutes a mild 
form, and change of living or air will often produce a complete 
cure, unaided by treatment of any kind. 

But there is a graver form, the " true cancrum oris," and it is 
very offensive, and often fatal. One of the cheeks becomes 
swollen, tense and shining, being excessively hard and presenting 
a red patch in the center. It is often difficult to open the mouth; 
in the inside will be seen a deep and excavated foul ulcer, opposite 
to the external swelling, covered with a brown, pulpy slough. The 
gums are turgid, dark and ulcerated; the saliva is mixed with 
putrescent matter, and as the ulceration in the mouth extends, the 
swelling sloughs, and a large, dark, circular and gangrenous cavity 
forms in the cheek, opening through into the mouth. It is a terri- 
ble disease, and makes us think of washes and lotions, but they 
are just as hurtful here as any other disease, and must be rigor- 
ously excluded from the treatment. Trust attenuations alone. 



104 Surgical Diseases of the Throat. 



Diseases of the Larynx. 

Laryngitis is spoken of as acute, or oedematous. The former 
is that in which the mucous membrane and cartilages are the seat 
of the disease. The latter is when the sub-mucous cellular tissue 
is involved. 

Inflammations of the larynx are always of a dangerous character. 
The danger lies in the liability to occlusion of the rima-glottidis, 
from swelling of the lips of the glottis, from plastic effusion, or from 
oedema. Spasms of the larynx and trachea are also to be taken 
into consideration, and are, to say the least, exceedingly unpleasant 
concomitants. The symptoms of the acute form are those indi- 
cating inflammation, and an obstruction to the proper performance 
of respiration. There is also some difficulty in swallowing, and 
tenderness of the larynx on pressure, more particularly on the 
pomum Adami. These symptoms speedily assume an alarming 
type, and result in death. 

(Edematous laryngitis presents many of the same symptoms, 
only in an intensified form. The fauces are seen to be swollen, 
dusky and pulpy; early dyspnoea, the voice becoming hoarse, 
rough, and eventually extinct ; much difficulty in swallowing. 
There are usually spasms of the larynx ; but, unlike the acute form, 
there is but little, if any, tenderness on pressure. As the disease 
progresses, we have a quick, small pulse, convulsive breathing, 
restlessness, clammy, pale face, dead-looking eyes, and stupor, fol- 
lowed by death. 

In the oedematous variety of laryngitis it is sometimes absolutely 
necessary to perform tracheotomy. 

Aphonia is a general term applied by allopathists to designate 
diseases of the larynx which they are pleased to call " incurable 
chronic," that are characterized by permanent alteration of the 
voice, and in some instances an almost total loss. Long-continued 
use of the voice in public (more especially in those not accustomed 
to it) will produce it, and as many ministers, from some reason or 
another, are so affected, it is commonly spoken of as "clergyman's 
sore throat." The term aphonia, however, is in this case misap- 
plied, as we have accustomed ourselves to using it as distinguishing 
a total loss of voice, and not a mere alteration. The portion of the 



Stricture of the Esophagus, 105 

throat usually affected is the rima-glottidis, which will be found to 
be chronically inflamed. In many instances, however, this inflam- 
mation extends some distance lower, and may even involve the 
vocal cords. The posterior nares, palate and fauces are found 
simultaneously affected. A secretion of thick puriform matter will 
be found hanging in a broad streak down one side of the posterior 
wall of the pharynx. 

Necrosis of the Cartilages is a death of the cartilages of the lar- 
ynx, due to one of the preceding diseases, but is most commonly 
noticed in cases of secondary or congenital syphilis. The more 
symptomatic indications are expectoration of large quantities of 
foetid puriform sputa, mixed with blood quite frequently, and 
occasionally containing portions of the dead cartilage. 

Abscesses often occur in connection with necrosis particularly, 
and they usually open externally. They may, however, from bur- 
rowing, dissect up the tissues for a long distance before pointing. 
When they open over the necrosed spot, aerial fistula will form, 
through which bubbles of air escape during respiration. 



Stricture of the Esophagus. 

Two kinds of stricture are noticed by surgeons : first, spasmodic, 
and second, the organic. 

Spasmodic Strictitre : This form is peculiar to hysterical women 
in a great measure, but is often produced by the irritation caused in 
the canal, consequent upon the procedure necessary in the removal 
of foreign substances that have become arrested here ; the constric- 
tor muscles of the pharynx seem to be the seat of the trouble As 
proof of its hysterical nature, it has been noticed that the attacks 
are periodical, and are brought on by attempting to swallow certain 
food, and occurs at some particular time of day. Not unfrequently 
it appears to be a variety of the globus hystericus. 

The Organic Stricture, unlike the preceding, is a veritable 
stricture. Either end of the canal may be the site, although the 
usual situation is that immediately back of the cricoid cartilage in 
the upper portion. The first difficulty experienced is an ineffectual 
attempt at deglutition, or that food returns to the mouth after 
having been partially swallowed. Death may result from one of 



106 Surgical Diseases of the Throat. 

two causes : either the patient dies from actual starvation, or else 
an abscess forms around the constricted place. A bougie, or pro- 
bang with the sponge removed, is absolutely necessary to forming 
a perfectly correct diagnosis. If the stricture be decided, a diffi- 
culty will be experienced in attempting to pass the instrument 
beyond that point. 



Diseases of the Parotid. 

Parotitis is readily cured. Suppuration but rarely occurs, and 
the only sequel to be dreaded is metastasis. The testicle and the 
mammary gland, as said in another place, are the choice seats of 
its re-appearance. 

Tumors here are of rare occurrence; that is, where a tumor 
grows from the gland, without the whole of the gland being 
included. They are of a fibrous nature, often encysted, hard, 
deeply attached, but movable. They are round, and often a very 
great size, up to that of a cocoa-nut even. They frequently send 
prolongations under the lower jaw, and then occupy the whole of 
the space between its angle and the mastoid process. When firmly 
bound down, they involve the blood-vessels and nerves of this 
important region, coming into relation with the styloid process and 
its muscles, and even pressing upon the pharynx. In consequence 
of the large size that these tumors may attain, they have a tendency 
to produce atrophy of the parotid, and often, by interfering with 
the cerebral circulation, occasion congestive symptoms. The paro- 
tid may undergo cancerous infiltration, the tumor presenting the 
characters and running the course of the ordinary forms of malig- 
nant disease. It is of importance to make out early the diagnosis 
between the malignant and non-malignant varieties. In the fibrous 
tumor there is always mobility, and although the attachment may 
be deep, the skin is not involved, and the outline of the mass is 
usually well defined, square, and somewhat lobulated. In the 
scirrhous growth, there is no mobility, but the mass is solidly fixed, 
its outline is ill-defined, the skin soon assumes a reddish-purple 
color, brawny, and presents the usual characters indicative of sub- 
jacent malignant action. When the tumors are medullary, they 
grow with considerable rapidity, feel soft, pulpy, and are ill-defined 



Bronchocele. — Hyp ertroph zed Tonsils. 107 

in their outline, especially under the ear, and by the ramus of the 
jaw. 

Tumors of the Neck. — One variety is peculiar to this locality, 
and is called hydrocele of the neck. It is a cystic tumor, appearing 
in the posterior triangle, and is a large bladder-like mass, and may 
be single or multilocular. The cysts are filled with a fluid of any 
shade of color from that of water to black ; or of any consistency 
from limpidity to a semi-solid form. They attain an immense 
size, and impede deglutition and respiration. 

Bronchocele. 

All tumors, as well as simple hypertrophies of this gland, have, 
of late, received the incorrect name of "goitre." M. Maumene, a 
French chemist, contends that goitre is caused by the presence of 
the fluorides in the water. He gave a dog Fluoride of potassium 
for some time (five months), and at the end of that time had suc- 
ceeded in producing a swelling of the gland, that, though small, 
was quite distinctive. 

The tumor so formed, whatever be the cause, may include a por- 
tion or the whole of the gland, and is often, apparently, in two 
distinct sections. When large, they are a source of danger from 
the pressure exerted on the windpipe. 

Ex-ophthalmic Goitre is an abnormal condition noticed in con- 
nection with these enlargements, and although no distinct connec- 
tion has been as yet traced between the prominent eyes and 
palpitating heart and the tumor, yet they are so frequent a coinci- 
dence that it is impossible not to regard them in the light of cause 
and effect. There is usually also a pale and anaemic countenance, 
with the unusual prominence of the eyes. 

In London, pale and bloodless girls are quite commonly affected 
with bronchocele in a greater or less degree. I have had two 
cases like this, and in each, whenever the patient became excited, 
particularly from grief, the tumor would increase perceptibly in 
size, and pulsate very strongly. 

Hypertrophied Tonsils. 

This enlargement is met with in all degrees, from a simple 
inflammatory condition to a chronic hypertrophy and induration. 



108 Surgical Diseases of the Throat. 

Struma is usually the cause of chronic enlargement, though when 
the glands have been once swollen, they readily become so again. 
Excision is a favorable allopathic remedy, but I never practice it. 
Therapeutics. — The remedies to be employed in the treat- 
ment of these diseases are as follows: Aeon., Alum., A?nm. c, Ant. 
c, Apis, Ars., Aur., Bapt., Baryta, Bell., Brom., Cale., Canth., 
Capsic., Carbo v., Caust., Cham., Cistus e., Coff., Con., Dule., Dros., 
Gelsem., Hepar, Hyos., Ign., Iod., Ipee., Kali bich., Kali e., Kreos., 
Lach., Led., Lye., Mang., Merc., Nat. c., Nat. m., Nit. ac., Nux 
vom., Petrol., Phos., Phytol., Podoph., Puis., Rhus, Samb., Sang., 
Senega, Sepia, Sil., Spong., Staph., Stram., Sulph., Tart, em., 
Thuja, Verat. 

The index may be arranged as follows : 
Tonsilitis: Baryta, Bell., Hep., Ign., Lach., Merc, Nit. ac, 

Nux v., Sulph. j Calc, Canth., Cham., Lye, Sep., Thuja. 
with Suppuration. — Baryta, Bell., Ign., Lach., Lye, Merc, 

Nit. ac, Sep., Hep. s. 

with Ulceration. — Baryta, Bell., Ign., Lach., Lye, Merc, 



Nit. ac, Sep. 

Pharynx: Simple Inflammation of. — Aeon., Bell., Canth., Lach., 
Merc, Phytol. 

Polypi in. — Ars., Calc, Lach., Merc. 

Esophagus : Spasmodic Stricture of. — Bapt., Bell., Hyos., Lach., 
Stram., Verat. ; Con., Lye, Merc, Nux vom^ Also study 
Aeon., Ars., Cicuta, Hydrop., Mezer., Natr. mur., Nit ae y 
Plumb. 

Organic Stricture. — Calc, Canth., Merc, Nux vom. 

Laryngitis; Acute. — Aeon., Hep., Spong. ; Cham., Dros., Lach., 

Merc, Ipee, Phos., Senega. 

(Edematous. — Apis, Ars., Calc, Carbo v., Caust., Cistus 

can., Phos.; Dros., Hep., Iod., Kreos., Led., Mang., Nit ac 

Aphonia : Ordinary. — Arum, Cham., Carbo v., Dule, Mere, Nux, 
Puis., Rhus, Samb., Sulph. j Bell., Calc, Capsic, Dros., Hep., 
Mang., Natr., Phos., Tart. em. 

Complete. — Ant. c, Bell., Caust., Merc, Phos., Sulph. 

Chronic. — Carbo v., Caust., Hep., Mang Petrol.. Phos., 

Sil., Sulph. j Dros., Dule, Rhus. 

from a Chill. — Bell., Carbo v., Dule, Sulph. 



Necrosis of Cartilages of the Larynx: Ars., Calc, Dule, 
Hep. s., Lach., Merc, Rhus, Sil., Sulph. 



Special Therapeutics. 109 

Parotitis : Merc, Aur. 

Erysipelatous. — Bell., Hyos. 

from Mercury. — Carbo v. 

Metastasis. — Carbo v. 

Bronchocele: Amm. c, Calc. c, Caust., Hep., Iod., Lye., Nat. 

c, Nat. m., Spong., Staph, j Bromine. 
Cancrum Oris: Ars., Aur., Borax, Capsic., Carbo v., Dulc., 
Lach., Merc., Nat. m., Nit. ac., Nux v., Staph., Sulph., 
Sulph. ac. 

Aconite nap. Tingling in the esophagus; acute inflammation 
in the throat, palate, tonsils and fauces, with high fever, dark red- 
ness of the part, and burning and stinging in the fauces ; stinging 
in the throat when swallowing and coughing; almost entire 
inability to swallow, with hoarseness ; inflammation of the larynx 
and bronchia; short, dry cough, from titillation in the larynx; 
expectoration of bloody mucus. 

Worse in the evening, and at night ; also during inspiration, and 
from cold in general. 

Better in the open air, and from warmth in general. Left side. 

Alumina. Sensation of constriction in the esophagus when 
swallowing ; sensation as if the esophagus were contracted when 
swallowing a small morsel of food ; the passage of the food is felt 
until it enters the stomach ; great dryness of the throat ; dry, short 
cough, especially in the morning, with dyspnoea; cough, with 
expectoration, in the morning ; hoarseness, especially in the after- 
noon and evening. 

Worse in the afternoon ; also on chewing. 

Better in the open air, and when eating, especially when eating 
or drinking warm things. Right side ? 

Ammonia Carb. When swallowing, sensation of a foreign body 
in the throat ; scraping and soreness in the throat ; hoarseness, and 
inability to speak a loud word, or swallow, or open the mouth ; 
cough dry, produced by a sensation like tickling in the throat pro- 
duced by dust ; cough, with spitting of blood, with previous sweet 
taste, and great dyspnoea; hard swelling of the right parotid gland 
after taking cold. 

Worse in the afternoon ; also when chewing, from cold, when 
eating, and from wet poultices. 

Better in the open air, from pressure, and from warmth in gen- 
eral. Right side. 



no Surgical Diseases of the Throat. 

Antimonilim Crud. Fine pinching in the region of the palate all 
night, especially painful during deglutition ; rough voice ; extreme 
feebleness of voice ; loss of voice whenever he became hot, return- 
ing when resting himself; sensation as of a foreign body in the 
throat; violent spasm in the larynx and pharynx. 

Worse in the morning, afternoon, evening and at night; also 
from wet poultices. 

Better in the forenoon, and in the open air. Either side. 

Apis mel. Dryness in the throat without thirst; burning-sting- 
ing in the throat ; inflammation of the throat, with swelling red- 
ness, and stinging pains; hoarseness in the morning. 

Worse in the morning, evening, and at night; also from heat, 
especially in the warm room. 

Better from cold water. Left side ? 

Arsenicum album. The mouth is reddish blue, inflamed and 
burning; secretion of abundant, tough, foetid and bloody saliva; 
painful, difficult deglutition, from constriction of the esophagus; 
burning in the throat ; dryness, burning and constriction in the 
larynx; respiration oppressed, anxious and short. 

Worse in the evening, and at night ; also from cold, on cough- 
ing, after drinking, while lying down. 

Better from warmth. Right side. 

Arum triph. Constant hawking; profuse secretion from pos- 
terior nares and fauces; voice uncertain, continually changing; 
hoarseness from talking ; submaxillary glands swollen ; foul, acrid 
secretion from nose and mouth excoriating lips and mouth ; corners 
of mouth sore, cracked and bleeding. 

Worse when attempting to drink or swallow. 

Aurum met. Painful swelling of the submaxillary glands; 
caries of the palate from abuse of mercury ; suffocating attacks, 
with suffocating oppression of the chest ; putrid cheese-like smell 
from the mouth ; (metastasis of parotitis to the testes ; the scrotum 
is swollen, hard, red and shining, hot, and covered with white 
scales. — G.) 

Worse in the morning, and at night ; also from cold. 

Better from warmth. Left side. 

Baptisia. Esophageal stricture; great aversion to open air, 
inability to swallow anything but liquids. 

Baryta Carb. Swelling of the submaxillary glands, with indu- 
ration ; inflammation of the throat, with swollen inflamed tonsils; 



Special Therapeutics. 



ii i 



sensation as from a plug in the throat ; sensation of smoke in the 
larynx ; hoarseness and loss of voice, from tough mucus in the 
larynx and trachea. 

Worse at night ; also from cold, when eating, from pressure, and 
on swallowing, from suppression of sweat of the feet. 

Better from warmth. Either side. 

Belladonna. Swelling and inflammation of the submaxillary 
glands ; inflammatory swelling and redness of the inner mouth and 
soft palate ; inflammation of the throat, with sensation of a lump, 
which induces hawking, with dark redness and swelling of the 
velum palati ; burning and dryness in the esophagus ; stinging in 
the esophagus and in the tonsils ; the esophagus feels contracted ; 
spasms in the throat not permitting one to swallow; the drink 
returns through the nose, continual inclination to swallow ; tonsils 
inflamed and swollen, with ulcers rapidly forming on them ; larynx 
very painful, with anxious starts when touching it; constriction of 
the trachea; voice rough, with a nasal sound ; hoarseness and loss 
of voice ; painful swelling of the glands of the neck. 

Worse in the evening, and at night; also when drawing the 
breath, from cold in general, on coughing, from wet poultices, 
when swallowing drink, and when talking. 

Better from warmth in general. Right side. 

Bromium. Swelling and hardness of the left parotid gland ; 
inflammation of the throat, which is red and looks like a net, with 
corroded places ; burning from the mouth to the stomach ; heat in 
the mouth and esophagus; hoarseness, aphonia; soreness and 
roughness in the throat; tickling in the trachea during an inspi- 
ration ; two encysted tumors on both sides of the neck. 

Worse in the evening ; also in the warm room, and when at rest. 

Better from motion. Right side. 

Calcarea Carbonica. Inflammatory swelling of the parotid 
gland ; painful, hard swelling of the submaxillary glands ; spas- 
modic contraction of the esophagus ; inflammatory swelling of the 
palate, with blisters on it; stinging in the throat when swallowing; 
swelling of the tonsils ; hoarseness ; sensation as if something were 
torn loose in the trachea; ulceration of the larynx; tickling cough, 
caused by a sensation of dust in the larynx; thick, struma-like 
swelling of the thyroid gland. 

Worse in the morning, evening, and at night ; also while draw- 



\ 1 2 Stirgical Diseases of the Throat, 

ing in the breath, on coughing, during and after eating, from wet 
poultices, and from talking. 

Better when lying down, and in dry weather. Right side ? 

CantharideS. Burning in the mouth, extending down the phar- 
ynx and esophagus in the stomach; inflammation of the mouth 
and pharynx; inflammation and suppuration of the tonsils, with 
inability to swallow; painless inability to swallow; burning and 
stinging in the larynx, especially when attempting to hawk up the 
tough mucus ; hoarseness ; weak and indistinct voice. 

Worse in the afternoon, and at night ; also while drinking, from 
wet poultices, and when swallowing the drink. 

Better while lying down. Either side. 

Capsicum an. Burning blisters in the mouth; spasmodic con- 
traction of the throat ; inflammation, with dark redness and burn- 
ing', as from pepper in the throat. 

Worse in the evening, and at night ; also, while drawing the 
breath, from cold, when coughing, when lying down, from pressure, 
and when not swallowing. 

Better while eating, when swallowing, and from warmth in gen- 
eral. Either side. , 

Car bo veg. Swelling of the parotid gland; sensation of con- 
striction in the throat ; feeling of coldness of the throat ; burning, 
roughness, rawness of the throat ; the throat is full of mucus, that 
can be hawked up readily; swelling and inflammation of the 
uvula, with stitches in the throat ; hoarseness ; roughness of the 
throat causing cough ; soreness and ulcerative pain in the larynx 
and pharynx; loss of voice at night, or while talking; glands 
swollen and indurated. 

Worse in the morning and forenoon ; also in the evening or open 
air, during eating, from wet poultices, from pressure, and from 
talking. 

Better after lying down. Right side. 

CaUStiClim. Accumulation of much mucus in the mouth and 
throat ; constant disposition to swallow ; pain as if a tumor were 
in the throat; audible cracking in the throat; sensation as if some- 
thing cold were rising in the throat ; burning and roughness in the 
larynx; hoarseness and roughness in the larynx; swelling like 
goitre on the throat. 



Special Therapeutics. 113 

Worse in the evening, and at night ; also from cold in general, 
while and after eating. 

Better from warmth in general. Left side. 

Chamomilla Vlllg. Inflammatory swelling of the parotid gland; 
inflammation of the soft palate and tonsils, with dark redness ; sen- 
sation of a plug in the throat ; inability to swallow solid food ; sore 
throat, with swelling of the parotid and submaxillary glands ; 
wheezing and rattling in the trachea ; hoarseness from tenacious 
mucus in the trachea ; catarrhal hoarseness ; stitches and burning 
in the larynx, with hoarseness ; hoarseness and cough, from rattling 
mucus in the trachea ; inflammatory swelling of the glands of the 
neck. 

Worse in the evening, and at night ; also in the open air, during 
inspiration and from wet poultices. 

Better from cold. Either side. 

CistllS Can. Swelling of the parotid glands ; sensation of cold- 
ness in the tongue, larynx, and trachea, the saliva and breath feel 
cool ; dryness and heat in the throat, with constant swallowing of 
saliva to relieve it ; periodical itching in the throat ; fauces 
inflamed and dry, without feeling dry ; hawking up of thick, gum- 
like, tasteless phlegm ; stitches in the throat, causing cough when- 
ever mentally excited ; feeling as if trachea was not wide 
enough ; pain in the trachea ; feeling of rawness extending from 
the upper part of the chest into the throat ; glands of the neck and 
throat are swollen ; scrofulous swelling and suppuration of the 
glands of the throat. 

Worse in the evening, night, and in the morning ; also in the 
cold air, when lying down, from drinking coffee and from motion. 

Better in the fresh air. Right side. 

Coffea CPUda. Swelling and painfulness in the throat ; short, 
dry cough, as from constriction of the larynx. 

Worse in the morning and at night ; also when in the open air. 

Better from cold water. Either side. 

Conium mac. Induration of the parotid gland; pressure in the 
esophagus, as if a round body were ascending from the stomach ; 
spasmodic constriction of the throat ; swelling of the glands, with 
stinging and stitches after contusions and bruises ; hard swelling 
of the glands. 

Worse in the morning, and at night ; also in the open air, from 
cold ; when eating ; when lying down. 



ii4 Surgical Diseases of the Throat. 

Better from pressure and from warmth. Either side. 

Dulcamara. Continual hawking up of very tough saliva, with 
much rawness in the fauces ; cough, with expectoration of bright 
blood ; hoarseness ; swelling of the glands of the neck. 

Worse at night ; also, from cold, when lying down, and in wet 
weather. 

Better from warmth, and in fine weather. 

Drosera rot. Sensation of dryness in the throat ; ulceration of 
the velum palati ; stinging in the throat during deglutition ; sensa- 
tion in the pharynx as if crumbs had remained behind ; difficulty 
in swallowing solid food, as if the esophagus were contracted ; 
scraping in the throat from eating salt food; hawking of green or 
yellow mucus ; continuous dryness and roughness in the larynx ; 
inflammation of the larynx and pharynx, causing pain when talk- 
ing ; deep, cracked voice ; laryngeal and tracheal phthisis. 

Worse in the morning, at night, and towards morning ; also 
during expiration, when lying down, from talking and from 
warmth in general. 

Better from cold. Right side. 

Gelseminum. Dryness and burning in the throat ; dryness of 
the throat, with hoarseness ; sensation of heat and constriction in 
the throat; burning in the mouth, extending to the throat and 
stomach ; sensation as if a foreign substance were lodged in the 
throat ; difficult deglutition ; voice weak, paralysis of the glottis, 
with difficult deglutition ; spasm of the glottis in the evening, 
threatening suffocation ; roughness in the throat ; raw, as if ulcer- 
ated in the larynx ; hoarseness, with dryness of the throat ; burn- 
ing in the larynx, descending into the trachea. 

Hepar SUlph. When swallowing, sensation as if there were a 
plug in the throat, or as if a splinter were sticking in it ; scraping 
in the throat when swallowing the saliva ; swelling of the tonsils 
and glands of the neck ; dry throat ; stitches in the throat, extend- 
ing to the ear ; wheezing, and painfulness of a small spot, in the 
larynx ; swelling below the larynx ; roughness in the throat ; 
hoarseness. 

Worse in the morning, forenoon, evening, and at night ; also 
during inspiration, from chewing, from cold, when coughing, 
when eating, from pressure, and when swallowing the food or 
saliva. 



Special Therapeutics. 115 

Better in damp, wet weather, and from warmth in general. 
Left side. 

HyOSCyaiTlUS nig. Constriction of the throat, with inability to 
swallow, especially fluids ; parching dryness of the fauces ; elonga- 
tion of the uvula ; rough voice, from mucus in the trachea and 
larynx. 

Worse in the evening ; also when chewing , from cold in gen- 
eral ; when drinking. 

Better from warmth ? Either side. 

Ignatia am. Redness, inflammation and soreness of the inner 
mouth ; stitches in the soft palate, extending to the ear ; stitches in 
the throat, when not swallowing; sensation as of a lump in the 
throat when not swallowing ; when swallowing, sensation as if he 
swallowed over a lump, with soreness and crackling noise ; 
inflamed, swollen and indurated tonsils, with small ulcers on them ; 
pain in the submaxillary glands when moving the neck ; sensation 
of soreness in the larynx ; constrictive sensation in the trachea and 
larynx ; low voice ; painless glandular swelling in the neck. 

Worse morning, afternoon, evening, and in the night ; also 
during <?.Ypiration, on chewing and when not swallowing. 

Better during Aspiration, when eating, when swallowing, and 
from warmth. Either side. 

lodilim. Swelling and elongation of the uvula ; inflammation 
of the throat, with burning pain ; burning in the fauces ; constric- 
tion of the throat, with impeded deglutition; inflammation of the 
larynx and trachea ; pain in the larynx, with discharge of hard- 
ened mucus ; contraction and heat in the larynx ; increased secre- 
tion of mucus in the trachea ; the voice becomes deeper ; hoarse- 
ness ; swelling of the neck ; strumous enlargement and painful 
induration of the goitre ; sensation of constriction in the goitre ; 
swelling of the glands of the neck ; swelling of the thyroid gland. 

Worse in the evening, and at night ; also during expiration, 
while drinking, from pressure, and from warmth in general. 

Better from cold. Either side. 

Ipecacuanha. Spasmodic contractive sensation in throat ; 
fauces are stinging, rough, sore, and dry ; swelling in the pit of the 
throat which eventually suppurates. 

Worse in the evening : also on coughing. 

Better in the open air. Either side. 

Kali bich. Erythema of the fauces and soft palate, bright or 



n6 Surgical Diseases of the Throat. 

dark red, or of a coppery color; the soft palate slightly reddened, 
uvula relaxed, and sensation of a plug in the throat, which is not 
relieved by swallowing ; deep, excavated sore, with a reddish areo- 
lar, containing a yellow tenacious matter, at the root of the uvula ; 
the fauces and palate presenting an erythematous blush ; the poste- 
rior wall of the pharynx is dark red, glassy, puffed, showing rami- 
fications of pale red vessels ; on the middle, toward the left side, a 
small crack from which blood exudes ; sharp, shooting pain in the 
left tonsil toward the ear, relieved by swallowing ; burning in the 
pharynx, extending to the stomach ; in the fore part of the palate, 
on single circumscribed spots of the size of a barley-corn, colored 
red, as if little ulcers were about to form ; ulcer on the roof of the 
mouth, with sloughing ; ulceration of the uvula and tonsils ; sensa- 
tion as from ulceration in the larynx ; hoarse, rough voice ; tickling 
in the larynx, every inhalation causes cough ; the complaints 
appear periodically, at the same hour. 

Worse in the morning ; also from cold, after eating," and in the 
summer. 

Better from heat. Left side ? 

Kali Carb. Inflammation and hard swelling of the parotid 
gland ; sensation of dryness in the mouth, with increased secretion 
of saliva, painful vesicles all over the inner mouth, with burning 
pain ; stinging pain in the throat when swallowing ; difficult deglu- 
tition ; the food descends very slowly in the esophagus, and small 
particles are apt to get into the larynx ; roughness of the throat ; 
complete aphonia ; hard swelling of the submaxillary gland. 

Worse in the morning, evening, and at night; also during 
inspiration, from cold, when eating. 

Better from warmth. Left side. 

KreOSOte. Scraping in the throat, with roughness and dryness. 

Worse in the morning ; also in the open air, on moving, and from 
cold food. 

Better from warmth. Right side. 

LachesiS. Much slimy saliva, especially at the back part of the 
mouth ; sensation of a plug in the throat, or as if a lump of mucus 
in the throat, with continual desire to swallow ; the fluid which is 
swallowed escapes through the nose ; ulcers in the throat and on 
the inflamed tonsils ; empty swallowing aggravates the pain in the 
throat more than swallowing of the food, and fluids swallowed 
with less pain than solids ; can not swallow the food after masti- 



Special Therapeutics. 117 

eating it, because it rests on the back part of the tongue and pro- 
duces a thrilling pain there ; tonsils swollen, mostly the left one ; 
when swallowing, the pain extends to the left ear ; the inflamma- 
tion and ulceration in the throat begin on the left side, and later 
extend over to the right ; the external throat is very sensitive to 
the touch ; hoarseness, with sensation of rawness and dryness in 
the larynx. 

Worse in the evening, and at night ; also in the open air, and 
when swallowing the food and the saliva, and after sleep. 

Better during inspiration, while eating, and in dry weather. 
Left side. 

Ledum pal. Glandular swellings under the chin ; sore throat, 
with fine, stinging pain, worse when not swallowing ; sensation as 
if from a lump in the throat ; when swallowing, the pain is sting- 
ing ; tingling in the trachea. 

Worse in the evening, and at night ; also from warmth, from 
motion, and the heat of the bed. 

Better from cold, and when swallowing. 

Lycopodium. Swelling of the submaxillary glands ; the poste- 
rior part of the mouth is covered by a tough mucus ; inflammation 
of the throat with stitches in swallowing ; the tonsils are swollen, 
and suppurate ; ulceration of the tonsils begins on the right side ; 
the pharynx feels contracted, nothing can be swallowed ; hoarse- 
ness ; the voice is feeble and husky ; stiffness and swelling of one 
side of the neck. 

Worse in the afternoon (from 4 p.m. to 8 p.m.), evening, and at 
night ; also during inspiration, during eating, while lying down, 
and from pressure. 

Better from pressure, and in dry weather. Right side. 

Manganum. Cutting soreness in the throat, between the acts 
of deglutition; when swallowing, dull stitches on both sides of 
the larynx, extending to the ear , dryness and scratching of the 
throat, with a sensation as if a leaf were stopping it up ; red, swol- 
len streak on the left side of the neck. 

Worse in the evening, and at night ; also on stooping, and on 
being touched. 

Better from pressure, and in dry weather. Either side. 

MerCllriuS. Inflammatory swelling of the right parotid gland, 
with stinging; inflammatory swelling of the inner mouth; ulcera- 
tion of the salivary glands ; pain when swallowing, as if a foreign 



Ii8 Surgical Diseases of the Throat. 

body were being swallowed down ; burning in the throat, as if 
from hot vapor ascending from the stomach, with a dryness in the 
throat when swallowing, though continuous desire to swallow, 
with accumulation of water in the mouth ; redness and pain in the 
throat ; erysipelatous inflammation of all the soft parts of the 
mouth and throat ; inflammation and redness of the palate ; the 
fluid is returned through the nose ; sticking pain in the tonsils 
when swallowing; hoarseness, with burning and tickling in the 
larynx ; inflammation and swelling of the glands of the neck, with 
pressing pains and stitches. 

Worse in the evening, and at night ; also in the evening air, 
when drawing in the breath, when swallowing the drink, and 
from warmth in general. 

Better from cold, and in dry weather. Right side. 

Nafrum Carb. Flat ulcers and blisters inside of the mouth, 
burning and painful when touched; the throat and esophagus feel 
rough, scraped and dry ; swelling of the glands of the neck ; pain 
and pressure in the goitre. 

Worse in the morning, and in the evening ; also before eating, 
from talking, and from the slightest exertion. 

Better from motion, on pressure, or on rubbing. Either side. 

Natmm mur. Swelling of the submaxillary glands; ulcers in 
the mouth and on the tongue, also blisters, that have a smarting, 
burning pain when touched by the food ; swelling, with sensation 
of constriction, and stitches in the throat ; long-continued sore 
throat, with sensation as if she had to swallow over a lump; 
hoarseness, with dryness in the larynx. 

Worse in the morning, forenoon, and night ; also on drawing 
the breath when chewing, on eating, from pressure, and when 
swallowing. 

Better while lying down. Right side ? 

Nitric acid. Painful swelling of the submaxillary glands ; 
ulcers in the mouth and fauces, with pricking pains ; inflamma- 
tion of the throat, with pricking pains or with burning and sore- 
ness, after the abuse of mercury ; painful soreness of the soft palate, 
the tongue, and inside of the gums, with stinging pain and ulcera- 
tion of the corners of the mouth ; great dryness and heat in the 
throat ; scratching and stinging in the larynx, with hoarseness, 
especially after talking a long time, in syphilitic persons. 



Special Therapeutics. 119 

Worse in the morning, afternoon, evening, and at night ; also 
from touching the parts, when swallowing the food. 

Better on getting warm. Either side. 

NliX Vomica. Swelling of the submaxillary glands, with sting- 
ing on swallowing ; inflammatory swelling of the throat, roof of 
the mouth and gums, with difficulty of deglutition ; sensation as 
of a plug in the throat ; sensation of soreness in the throat on inhal- 
ing cold air ; when swallowing, stitches in the throat, with sensa- 
tion as if it were too narrow, or constricted ; inflammatory swelling 
of and stitches in the palate ; suffocative attacks after midnight, 
from spasmodic constriction of the larynx ; itching in the larynx. 

Worse in the morning ; also from motion, and on being lightly 
touched. 

Better from strong pressure. Left side. 

Petroleum. Swelling of the submaxillary glands ; stinging 
pain in the throat when swallowing ; ulcers on the inner cheek, 
painful when closing the teeth ; when swallowing, the food enters 
into the posterior nares ; swelling and induration of the glands. 

Worse in the morning, and in the evening ; also from cold in 
general. 

Better from warmth, and in the warm air. Right side. 

Phosphorus. Burning in the esophagus ; dryness of the throat 
day and night ; spasmodic constriction of the esophagus ; the ton- 
sils and uvula are much swollen ; hoarseness and loss of voice ; 
great painfulness of the larynx, preventing talking ; stitches, sore- 
ness, dryness, and roughness of the larynx. 

Worse in the morning, evening, and at night ; also after eating 
anything warm, and when the weather changes. 

Better from eating anything cold. Left side. 

Phytolacca dec. Sensation of dryness in the throat and poste- 
rior fauces ; sensation of a lump in the throat, which causes a con- 
tinual desire to swallow ; bronchocele (Hale) ; glandular enlarge- 
ments. 

Worse in the morning and afternoon ; also in the latter part of 
the night. The symptoms may appear on either side. 

Podophyllum pelt. Dryness of the throat ; rattling of mucus in 
the throat; inflammation, induration and suppuration of the 
glands ; goitre ; sore throat commencing on the right side and 
going to the left. 

Worse in the morning. 

Better in the evening. 



120 Surgical Diseases of the Throat. 

Pulsatilla. Pain in the throat, as if sore and raw ; stinging, 
with pressure and tension in the throat, on empty swallowing ; 
inflammation of the throat, with distension of the veins ; hoarse- 
ness, which does not admit of speaking a loud word ; breathing is 
groaning or rattling. 

Worse in the evening, and at night ; also from warmth, after 
eating, and when lying down. 

Better in the open air, and from cold. Left side. 

Rhus tOX. Inflammatory swelling of the left parotid gland; 
suppuration of the parotid glands ; sore throat, as from an internal 
swelling, with bruised pain, also when talking, with pressure and 
stinging when swallowing; difficult swallowing of solid food, as 
from contraction of the esophagus ; sensation of coldness in the 
larynx when breathing ; hoarseness, with roughness in the larynx, 
and roughness and soreness in the chest ; hot air rises from the 
trachea. 

Worse in the morning, and at night ; also when at rest, from 
damps, from cold, and when swallowing. 

Better from motion, and from warmth. Left side. 

SambuCUS nig. Dryness of the throat and mouth, but without 
thirst ; inflammation of the larynx and trachea. 

Worse in the night ; also when at rest. 

Better from motion and on sitting up in bed. Either side. 

Sancjuinaria Can. Ulcerated sore throat ; feeling of swelling in 
the throat on swallowing ; feeling of dryness in the throat not 
relieved by drinking ; heat in the throat, which is relieved on the 
inspiration of cold air; dryness of the throat, and sensation of 
swelling in the larynx. 

Worse in the morning and evening ; also, from noise or motion. 

Better when lying still. 

Senega. Burning in the throat, mouth, and on the tongue; 
inflammation and swelling of the throat and palate ; dryness of the 
throat, with accumulation of tough mucus which is difficult to 
hawk up ; hoarseness. 

Worse in the evening ; also when at rest. 

Better from walking in the open air. Left side. 

Sepia. The tongue and cavity of the mouth feel as if scalded; 
dryness of the throat, with tension and scraping ; soreness, and 
stinging in the throat, with swelling of the submaxillary glands; 
sensation as if from a plug in the throat ; roughness and soreness 



Special Therapeutics. 121 

in larynx and throat ; hoarseness, with dry cough, from titillation 
in the throat, with coryza ; feeling of dryness in larynx. 

Worse in forenoon, and evening ; also, after eating, and when at 
rest. 

Better from warm air, and from violent exercise. Left side. 

Silicea. Hard swelling of the parotid gland ; painful swelling 
of submaxillary gland ; sore throat, with much mucus in throat ; 
when swallowing, soreness and stitches in throat ; swelling of the 
palate ; difficult deglutition, as if from paralysis ; when swallowing 
the food gets into the posterior nares ; hoarseness, with roughness 
of the larynx ; painless glandular swellings ; glands swell without 
pain, but cause unpleasant itching ; suppuration of the glands (with 
thin, fetid, watery, or flakey pus — G.). 

Worse in the night ; also, in the open air, from cold, or getting 
wet, after eating, from pressure, when sleeping. 

Better from warmth. Right side. 

Spontjia tOSta. Swelling of the submaxillary glands, with ten- 
sion ; mouth and tongue full of vesicles, with burning and stinging 
pains, on that account can not eat any solid food ; weak voice ; 
difficult respiration, as from a plug in the larynx ; spasmodic con- 
strictive pain through the chest and larynx ; sensitiveness of the 
larynx to the touch, and when turning the head ; pressure in the 
larynx when singing ; inflammation of the trachea and bronchiae ; 
large goitre, with stinging, pressing and tingling pain ; painful stiff- 
ness of the muscles of the neck and throat. 

Worse at night ; also, from smoking tobacco. 

Better when at rest. Right side. 

Staphisagria. Hardness of hearing, with swelling of the ton- 
sils after abuse of mercury ; painfulness of the submaxillary glands, 
with or without swelling ; throat dry and rough, with soreness when 
talking or swallowing ; when talking she swallows continually ; 
rawness in the larynx from talking; hoarseness, with much tena- 
cious mucus in larynx and chest. 

Worse all times of day, except evening ; also, from touch. 

Better after lying down. Left side ? 

Stramonium. Difficult deglutition, from dryness, and spas, 
modic constriction of the throat ; constriction of larynx ; fine, 
shrieking voice ; fear of water, and aversion to all fluids. 

Worse in the morning ; also, after sleep, from being touched. 

Better when in company. Left side. 



122 Surgical Diseases of the Throat. 

Sulphur. Long-continued sensation of a lump in the throat; 
sensation as if swallowing a piece of meat during empty degluti- 
tion ; dryness of the throat ; stitches in the throat when swallow- 
ing; sensation of contraction in the throat when swallowing; 
elongation of the palate ; swelling of the palate and tonsils ; 
hoarseness and roughness of the throat, with much mucus in the 
chest ; deep, rough voice, aphonia ; coldness in throat during an 
inspiration. 

Worse in evening, or after midnight; also, when waking, on 
getting warm in bed, from talking, from touching the part, and 
from washing. 

Better during motion, and from heat. Left side. 

Tartarus St ibiatUS. Accumulation of rattling mucus in larynx 
and chest ; dryness of the mouth ; burning in the mouth ; inflam- 
mation of the mouth and mucous membrane of the tongue, with 
small pustules ; sudden swelling of the cervical glands and tonsils ; 
difficulty of swallowing. 

Worse in the evening ; also, from sitting, and from warmth. 

Better in cold, and open air. Right side ? 

Thuja OCCidentaliS. Accumulation of large quantities in the 
throat, which is hawked up with difficulty ; painful swallowing, 
especially empty swallowing, or of saliva only ; throat feels dry and 
raw, as if a plug were in it, with constriction when swallowing ; 
voice low. 

Worse in the evening and at night ; also, from cold wet, and from 
the heat of the bed. 

Better from warm wet. Left side. 

Veratrum album. The throat feels constricted as if by a press- 
ing swelling ; sensation of coldness or burning in the throat ; dry- 
ness in the throat, not relieved by drinking ; cold breath ; hoarse- 
ness. 

Worse in the morning ; also, after drinking and after sleep. 

Better after perspiration. Left side. 



SURGICAL DISEASES OF THE CHEST 

AND BREAST. 



Injuries of the Chest — Emphysema — Pneumo-Thorax — 
Traumatic Pneumonia — Empyema — Neuralgia of the 
Breast — Hypertrophy of the Breast — Inflammation 
of the Breast — Suppuration of the Breast — Malig- 
nant Tumor of the Breast. 

Injuries of the Chest. 

Wounds of the chest are chiefly important from the fact of their 
frequently being connected with wounds either of the heart or 
lungs. This wound may be inflicted by the same instrument pen- 
etrating the walls of the chest, or from the sharp end of a fractured 
rib, particularly if the fracture is oblique. From such a wound we 
have five serious complications that may occur, either separately or 
in rotation, viz. : Hemorrhage, Emphysema, Empyema, Pneumo- 
thorax, or Pneumonia traumatica. The hemorrhage alone will 
often be sufficient to produce death, and is a very troublesome oc- 
currence under the best of circumstances. Many measures are 
recommended for arresting it, but none of them are entirely satis- 
factory, particularly if the vessel wounded is one of considerable 
size. Pressure is the only thing that holds out any hopes of suc- 
cess, but unless the vessel is small, and a clot forms, death is 
almost certain. 

Wounds of the heart are usually fatal, although the direction of 
the wound in relation to the direction of the muscular fibres of the 
organ is somewhat to be considered. Wounds transverse to the 
fibres are more speedily fatal than when parallel. Wounds of the 
auricles are more rapidly fatal, also, than wounds of the ventricles. 
(Taylor's Med. Jurisp., p. 304, et seq.) In addition to the numer- 



124 Surgical Diseases of the Chest a7td Breast. 

ous incidents often quoted, going to show the length of time a man 
may live with a serious lesion of the heart, I may refer to one of 
very recent date. James Wilson, executed for murder in Hartford, 
Conn., October 13, 187 1, attempted suicide, by thrusting a piece 
of stout wire, one-sixteenth of an inch in diameter, and about four 
inches long, into the left ventricle. This was at two o'clock in the 
morning ; he lived, although in great pain, until his execution in 
the afternoon of the same day, between one and two o'clock. 

In addition to pressure, cold applications, and styptics, such as 
some of the preparations of iron, and, according to some, Erigeron, 
will be useful in arresting the hemorrhage. If the wound is made 
by a fractured rib, it must be reduced ; and if, after faithful effort, 
this seems impossible, resect it at once, for its presence will first 
induce pneumonia or pleuritis, and ultimately suppuration and 
death. The primary wound, i. e., when made by a knife, sword, 
or some like implement, is never to be enlarged, if possible, and the 
same rule holds good here ; if any portion of the instrument is 
remaining in the lung or chest, it must be removed if possible, 
notwithstanding individuals have lived for years with foreign 
bodies in these important viscera. 

Emphysema. 

This is an infiltration of air into the cellular tissue about the 
wound primarily, and from that may extend all over the chest and 
head. The appearances are, puffy swelling, paleness of the skin, 
and crackling on pressure. Nothing in a medicinal way holds out 
any prospect of a cure. The condition is purely mechanical, and 
must be treated mechanically. 

Pneumo-Thorax. 

This is produced in the same manner. It is an accumulation of 
air into the pleura, and is not uncommon in wounds of the lung 
proper. In this there is a complete absence, or a diminution, of 
the respiratory murmur, and yet is easily distinguished from solidi- 
fied lungs by the loud tympanitic sound given by percussion. 
There is at the same time, however, considerable distress in 
breathing. 

Pneumonia. 

When occurring from this cause (injury) this disease is identical 



Hypertrophy of the Breast, 125 

with the idiopathic form, and needs no mention in this place. Of 
course, however, if we consider the cause, Aeon., Staph., and Ai-n. 
will be borne in mind, in preference to remedies that are oftener 
used in other cases. 

Empyema. 

This is a term that some construe to mean a collection of either 
blood or pus. The use of it in this connection is confusing, and I 
prefer to have it signify a collection of pus. It is a very serious 
affair, and the prognosis is always to be unfavorable. In very bad 
cases, where respiration is seriously interfered with, the pus must 
be evacuated by an operation similar to paracentesis thoracis ; but 
in by far the greater number of cases, I think, we have remedies 
that will almost surely induce absorption. Even when paracentesis 
is performed, it must be looked upon as purely palliative, for with- 
out good treatment the pus will be re-formed, and probably in 
greater quantities. In conclusion, it may be said that all these 
conditions, following injury of any of the contents of the chest, are 
very grave, and the prognosis should at least be guarded. 

Neuralgia of the Breast. 

This condition is usually met with in young persons, just passed 
through, or just entering the period of puberty; persons of a more 
advanced age are occasionally attacked, but so rarely that the 
reverse is the rule. Usually there is no change in the form or ap- 
pearance of the organ. Occasionally it is enlarged, however, and 
somewhat indurated. The most constant symptoms are, the pain 
peculiar to neuralgia elsewhere, cuticular sensitiveness (sometimes 
so excessive that the very lightest touch will greatly increase the 
sufferings), and a continuation of the pain in the axilla down the 
arm, as far as the elbow, and sometimes to the end of the fingers. 
A close examination will probably reveal some disease of the 
uterus, or its appendages, and by many the neuralgia is considered 
simply a reflex symptom. 

Hypertrophy of the Breast. 

Hypertrophy may be either simple or lobular. The former is the 
most common. In the first instance, the organ is not altered in 



126 Surgical Diseases of the Chest and Breast. 

shape, merely increased in size and weight ; it is usually compli- 
cated with a more or less persistent neuralgia, and is therefore 
peculiar to young women. As the disease progresses the breast 
hangs lower down the body, sometimes reaching as low as the 
knees, and the gland feels hard, elastic and unattached, just as if 
it were, to use a homely quotation, " a cocoanut in the end of a 
long bag." The appearance, on a superficial examination, would 
seem to indicate some malignant disease ; this is owing to the ten- 
sion the skin of the neck and back is subjected to. In the second, 
or lobular variety, the feeling and appearance is of several small 
tumors, movable and painless, but solid, which last for a short time 
only, being soon followed by atrophy, usually complete. This 
variety is nearly always seen in the middle-aged, and usually 
among the unmarried. 

c Inflammation of the Breast. 

Inflammation is quite common in nursing women, particularly 
for the first few days, although it has been observed at any period, 
and in persons of almost any age, from early girlhood to old age. 
It may terminate by resolution or suppuration, the latter, I fear, 
being the most common. 

Chronic abscess is usually found in this situation, and as it simu- 
lates many of various forms of tumor peculiar to this gland, con- 
siderable care is called for in making a diagnosis. 

Cancer of the Breast is sufficiently described in the chapter on 
" Tumors," and need not detain us here. It will be sufficient to 
say that the form most frequently observed is the scirrhus. 

Other tumors met with, of a non-malignant nature, are the same 
as those found in other parts of the body. The most common are 
cysts, hydatids, fibrous, cartilaginous, even osseous, and sarcoma. 
The following table is taken from Erichsen, and will prove of value 
in determining the nature of the growth you may have to deal 
with. But, before giving it, let me say one word of caution. All 
women, I believe, are very much afraid of cancer, and their fears 
lead them to suppose every abnormal swelling to be what they 
dread. Hence it must be only after close inspection (and study) 
that an opinion is risked. 



Special Tkerapezttzcs. 



12 j 



Non- Malignant. 

Feel : Moderately hard, nodulated, 
irregular in shape, more or less 
lobed, not very distinctly cir- 
cumscribed, sometimes elastic 
in parts. 

Mobility : Is considerable, but occa- 
sionally there is a deep pedun- 
culated attachment. 

Skin : Of the natural color through- 
out, though thin and expanded, 
with the tumor lying close be- 
neath. Only complicated in the 
• last stage of cystic sarcoma. 

Nipple : Usually not retracted. 

Veins: But little dilated. 

Pain : Often moderate, if severe con- 
tinuous, of a neuralgic charac- 
ter, much increased by hand- 
ling. 

Axillary Glands : Of usual size, or 
but slightly enlarged ; movable. 
Lymphatics not affected ; supra- 
clavicular glands not affected. 

No constitutional infection. 



Malignant. 

Of a stony hardness, knobby, dis' 
tinctly circumscribed, or else some- 
what square, and occupying the whole 
of the substance of the gland. 

At first considerable, but soon be- 
comes fixed to the deeper structures by 
a hard attachment. 

Becomes easily implicated ; at first 
dimpled, then red or purple ; in other 
cases brawny or leather-like, so that it 
can not be pinched up into folds ; or 
nodulated, purple-red masses form in it. 

Usually retracted. 

Much dilated. 

Severe and lancinating, especially at 
night, after handling, and when the skin 
is implicated, but not continuous. 

Enlarged, indurated and fixed ; in- 
durated mass of lymphatics under and 
parallel to the edge of the pectoral 
muscle, stretching into the axila ; su- 
per-clavicular glands enlarged. 

Cachexia as the disease advances. 



Therapeutics. — The remedies most frequently called for 
in the treatment of these diseases are quite numerous, and I can 
only give space to the few that are most prominently indicated. 
One fact must be borne in mind : If pus has actually been pro- 
duced in an inflamed breast, it must be evacuated. Many reme- 
dies, perhaps, are capable, of causing a re-absorption of it, but the 
result is slow at the best, and the pain is intense. Therefore 
humanity requires that the patient be relieved at once. 

In treating these diseases, then, consult, among others, the fol- 
lowing remedies : Apis mel., Am, Ars., Bell., Borax, Bry., Calc. 
c, Carbo an., Carbo v., Cham., Clem., Croton t., Con., Graph. (Helo- 
nias ?), Hep. s., Hyd. can., Ign., Iod., Merc, s., Murex, Nit. ac, 
Phos., Phytol., Puis., Sep., SiL, Sulph. 
Neuralgia of the Breast : Bell., Borax, Graph., Murex, Phos. r 

Sulph., (Calc, Apis, Ars. ) 
Hypertrophy : Con., Iod., Nit. ac. 
Atrophy : Con., Iod., Nit. ac. * 

Inflammation : Bell., Bry., Hep. s., Merc, Phos., SiL; Carbo an. f 
Carbo v., Con., Sulph. (Phytol.) 



128 Sttrgical Diseases of the Chest and Breast. 
of Nipples : Phos., Sil., Sulph., Croton t. 



Excoriation of Nipples : Am., Calc. c, Cham., Croton t., Graph., 

Ign., Puis., Sep., Sulph. 

Induration of Breasts : Bell., Carbo an., Clem., Con., Iod., Sep., 

Sil., Sulph., Cham., Merc, Phos. 

Suppuration of : Hep. s., Merc, Phos., Sil., or Kreas., PhytoL 

Nipples : Chain., Merc, Sil. 

Cancer of Breast : Ars., Clem., Sil., Am., Bell., Con. 

OtherTumors : Calc c, Carbo v., Hep. s., Merc, Sil., Sulph. 

Apis mel. Redness and inflammation of the breasts, with burning 
stinging pain j fever, but total absence of thirst; the pain is some- 
what allayed by using cold applications. 

Arnica mon. Erysipelatous inflammation of the mammae and 
and nipple ; inflammation of the breast following a contusion ; sore- 
ness of the nipples. 

Worse in the evening, and at night ; also, from motion, 'and from 
touch. 

Better when lying down. Right side. 

Arsenicum album. Inflammation of the breast, with burning 
pains; (feeling as if a red-hot iron were pushed deep into the 
gland. — G.); dark color of the skin, and threatened gangrene in 
spots ; severe burning pains ; scirrhus of the breast ; restless and 
nervous anxiety. 

Worse in evening, and at night ; also, from cold, and while lying 
down. 

Better from warmth. Right side ? 

Belladonna. Erysipelatous inflammation of the breasts, often 
occurring when weaning ; swelling and induration of the mammae ; 
swollen and hard breasts, with shooting or tearing pains, and ery- 
sipelatous redness, which emanates from a central point, and 
spreads out in radii ; heavy feeling in the breasts ; occasionally 
chilly ; a dull and stupid feeling prevails ; breasts swollen, hard, 
and shining, of a dark purplish redness, or bright red ; hot and 
painful. 

Worse in the evening, and at night ; also, from slightest touch, 
on moving, from wet poultices, from stepping hard on the ground, 
and when walking. 

Better while lying down, and from warmth. Right side. 



Special Therapeutics. 129- 

Borax. Sensation of contraction in the left breast, while the 
child is nursing from the right ; apthse on the nipples, with bleeding. 

Worse in the evening. 

Bryonia alba. Lumps, indurations and inflammation of the 
mammae, with diminished or retarded secretion of milk ; breasts 
hard, rigid, with tension or shooting pains in the tumor, and burn- 
ing heat externally; heat, fever, and excitability of vascular sys- 
tem ; stony heaviness in the breasts ; hot, hard, and painful, but 
not very red ; she feels sick on first sitting up in bed, or in a chair ; 
but still more sick on standing up ; rough, dry lips, thirst for large 
quantities but seldom, and constipation; stools dry, looking as if 
burnt. 

Worse at night, before midnight ; also, when bending down, when 
getting heated, when lying on the well side, when moving, on step- 
ping hard on the ground, and when touched. 

Better from cold, when lying on the back or painful side. Right 
side. 

Calcarea Carb. Hot swelling of the mammae ; secretion of milk 
either too abundant or else suppressed; soreness of the nipples, 
particularly on touching them ; perspiration, particularly about the 
head, which is so abundant that the pillow is wet far around ; pain 
as if bruised in breasts. 

Worse in the morning ; also, on bending down, before and during 
menstruation, from wet poultices, from pressure of the clothes. 

Better when lying on the back or painful side. Left side. 

CarbO animal. Mammae swollen and erysipelatous, particularly 
during confinement; hard, painful nodosities in the mammae ; dart- 
ing in the breasts, aggravated by pressure, and arresting the breath- 
ing. Right side. 

CarbO Veg. Erysipelatous inflammation in the mammae; burn- 
ing in the breasts ; scirrhus of breasts, with burning pains ; neural- 
gic nodes. 

Chamomilla. Milk cheesy, or mixed with pus ; suppression of 
milk ; erysipelas of the breasts, with soreness of the nipple ; indu- 
ration and swelling of the breasts, painful to the touch ; excessively 
sensitive to pain ; hardness of breasts ; drawing lacerating pain in 
indurated breasts ; scirrhus. 

Worse in the night, before midnight ; also, when lying down (on 
the painless side), during menstruation, and from the warmth of the 
bed. 



1 30 Surgical Diseases of the Chest and Breast 

Better from cold. Left side. 

Clematis erecta. Swelling and induration of the breasts ; can- 
cer of the breast ; glandular induration above the nipple, painful 
when touched. 

Crofon tig. Pain and stitches through the breast into the chest, 
and extending to the back, as soon as the child begins to nurse ; 
darting pain from the nipple straight through to the back. 

Conium mac. Inflammation of breast, with stitches; scirrhus 
from contusion ; itching of the breast and nipple, with red, scaly 
skin, and burning after rubbing ; hypertrophy of breast, either gen- 
eral or lobular, followed by atrophy ; mammae always become very 
tender before menses ; (skin dark red, swelling and hardness, with 
an aching dull pain. — G.) 

Worse in the morning and at night ; also, from cold, when lying 
down, sitting or standing. 

Better from warmth, and from walking. 

Graphites. Swelling and induration of the glands ; soreness of 
the nipples, with small corrosive blisters ; useful in cases of threat- 
ened suppuration, when the breasts are marked with many cica- 
trices from former ulcerations. 

Hepar SUlph. Itching of the nipples ; scirrhus ulcer in the 
mammae, with stinging-burning in the edges, smelling like old 
cheese ; useful in promoting suppuration when a former acute pain 
suddenly ceases after a chilly feeling, and is followed by a beating 
pain, or throbbing, indicating the formation of pus. It is used to 
promote suppuration, and hasten the discharge. 

Iodine. Dwindling and complete disappearance of the breasts ; 
acute pain in the breasts, as if sore and ulcerated ; blue-red furun- 
culus nodosities in the skin of both breasts, with black dessicated 
points at the tips ; the breast first enlarges slightly, then becomes 
indurated, finally almost entirely disappears. 

MerCUrilJS. Hard swelling of the breasts, with sore and raw 
sort of pain ; milk is so deteriorated that the child refuses it ; 
scorbutic gums ; they recede from the teeth ; hard swelling and 
suppuration of the breast, with sore pain and ulcerated nipples ; 
swelling of the mammae, particularly of the nipples ; periodical 
pain in the breast, as if from threatened suppuration. 

Worse in the night ; also, from the heat of the bed. 

Better from cold. Left side. 



Special Therapeutics, 



Ui 



Mlirex pur. Violent pain in the breast, with acute stitches. 
Right side chiefly affected, and worse at night. 

Nitric acid. Nodosities in the mammae; atrophy; hard knots 
in the breast. 

Phytolacca dec. Inflammation of breast, with hardness from 
the first ; sensitive and painful, even after suppuration has taken 
place ; pains pressing, shooting, and severe. 

Worse in the morning, and afternoon. 

Better before breakfast, and in the forenoon. 

Phosphorus. Ulceration of the breast, with hardness ; bluish 
color, with burning and stinging fistulous openings ; stitches in the 
breast; hard and painful nodosities; erysipelas, with swelling; 
burning stinging and suppuration; stinging and cutting pain; 
hectic fever and night sweats. 

Worse in the morning and evening ; also, when lying on the 
back, and when walking. 

Better when quiet or reposing. Left side. 

Pulsatilla. Swelling of the breasts, with pressing tension, as if 
milk would appear in them ; painful sticking, and a discharge of 
thin acrid milk. 

Worse in the evening, and at night ; also, from warmth. 

Better from cold, and in the open air. Right side. 

Sepia. Stinging in the breasts, with soreness of the nipples. 

Silicea. Inflammation of the nipples ; induration and suppura- 
tion of the breast ; fistulous ulcers, the discharge thin and watery, 
or thick and offensive ; the substance of the mammae seems to be 
discharged with the pus, as one lobe after another disappears, 
suppurating and discharging through one common fistula ; or else 
there is a number of fistulse, one for each lobe. 

Worse in the forenoon, and at night; also, from cold, bodily 
exertion, lying on the back or painful side, from pressure, and from 
being touched. 

Better while lying on the painless side, and from warmth. Right 
side. 

Sulphur. Inflammation running in radii from the nipple ; chil- 
liness in fore part of the day, and heat in the after part, with very 
profuse suppuration ; swelling of breasts ; nodosities ; nipples 
cracked, burning and stinging; erysipelatous inflammation of the 
breast, with heat, hardness, stinging and redness extending from 
the nipple ; itching of the nipples. 



132 Surgical Diseases of the Chest and Breast, 

Worse in the evening, and at night ; also, during menstruation, 
when moviag the arms, while standing, when stepping hard on the 
ground, from being touched, and from the warmth of the bed. 

Better from cold. Left side. 

Operations. 

The only operation 1 that needs any mention is that of amputa- 
tion of the whole breast, or only a portion. It is one that must 
never be undertaken without first being assured that it is demanded 
to save life ; for the mutilation is a cruel one, and I can imagine 
only one instance in which it is positively demanded. That is in 
general hypertrophy, when the gland is very much enlarged. In 
cancer it is worse than useless, and should rarely, if ever, be per- 
formed. But should the occasion arise, use the knife ; first, because 
it is more certain, and less painful ; and second, because plasters 
and escharotics are the weapons of the charlatan. 



SURGICAL DISEASES OF THE SPINE. 



Injuries of the Spine — Caries — Lateral Curvature — 
Spina Bifida and Myelitis. 

Injuries of the Spine. 

The spinal cord is liable to wounds, compression, concussion and 
inflammation j the vertebrae are sometimes dislocated, fractured, or 
there may be a combination of the two. 

Dislocation is an accident that many authors and surgeons say 
can not occur ; the structure of the column is such that there can 
be no luxation uncomplicated with fracture. With the exception 
of the dislocation of the axis from the altas, I do not see how any 
other bones can be displaced. Formerly it was considered that 
death from hanging was caused by a dislocation of the axis, and 
consequent compression of the cord. Of late years, tables have 
been published, which show that such results are exceedingly rare; 
nervous shock and suffocation being the direct cause. This luxa- 
tion has, however, occurred in the case of children, from the vio- 
lence of a nurse, or during play, and death must ensue immediately. 
Still an effort should be made in every case to reduce this, and 
when seen immediately after the accident, life may be restored. 
Place the knees on the patient's shoulder, and make traction by 
the head. When a fall, or heavy blow, has produced this accident, 
and one of the other vertebrae are displaced, death is not certain, 
but paralysis is. Make an effort to reduce the luxation, and ad- 
minister Ar7i. Sometimes, when this fails, Ruta grav. will be 
found useful. The accident is readily diagnosed, and will give no 
embarrassment. The deformity is considerable, and motion is 
entirely lost at that point ; there is also acute pain and paralysis of 
all the muscles below that position. 

Fracture is a more common accident, and is equally unfortunate. 



134 Surgical Diseases of the Spine. 

But little can be done beyond mere palliative measures. The 
construction and situation of the spine make it an impossibility to 
adapt any dressing to the part that will retain the fragments in 
place, even if they can be reduced. This accident may occur with 
or without compression of the cord, consequently paralysis may 
or may not be present. When this is the case, the prone position 
must be maintained, an air or water-bed used to guard against 
pressure. Perfect quiet, and the administration of Symphytum to 
aid in promoting bony consolidation, will be the line of treatment. 
It has happened that even when the cord has been compressed, or 
paralysis induced from other injuries, recovery has followed, but 
the functions of the paralyzed parts are but imperfectly estab- 
lished. 

Compression of the cord is easily known. When we have defor- 
mity and paralysis below the seat of pain, you know there is com- 
pression, and either fracture or dislocation ; which one of these 
accidents it is, is comparatively easily told. The first thing to be 
done is to relieve and keep off pressure. When there is fracture 
of some of the processes, so that one of the bones has nothing to 
hold it in place, the danger is much greater, and the prospect is 
that your patient will die. Compression from a depressed fracture 
of the arch, is to be reduced by cutting down on the bone, and 
removing the fragments, if necessary, with the trephine. After the 
pressure is removed, Arnica will be necessary, and, with complete 
rest, may restore the patient, although the functions of the paral- 
yzed parts may never be perfectly regained. 

Concussion of the cord is produced by the jar consequent upon 
a person's falling, or jumping from a height, and alighting heavily 
on the feet. There is great pain in the spine, inability to stand, 
and weakness in the lower limbs. The symptoms may be grave 
from the beginning, or commence lightly and increase in severity 
as the case progresses. The sphincters are relaxed, and, in common 
with other muscles and functions, paralyzed. The bladder loses 
its expulsive property, and is only saved from rupture by over-dis- 
tention, from the urine dribbling away as fast as secreted, owing to 
the relaxation of the neck. In slight cases, recovery will often 
ensue unaided. But when -the accident is severe, death will be 
very apt to ensue, Inflammation, followed by softening of the 
cord, is a common result ; and examination after death will reveal 
disorganization to any extent. 



Caries of the Spine. 135 

Myelitis, or inflammation of the spinal cord, differs from the other 
accidents in there being pain and paralysis, but no deformity of 
the spine itself. Am. or Con. will ordinarily be all that is required. 

Wounds, by sharp-pointed instruments, of the spinal cord, are 
occasionally met with, and are more unpromising and embarrass- 
ing than any of the above accidents. Frequently the cord is com- 
pletely divided, when complete paralysis, lowering of the tempera- 
ture, cessation of nutrition, and feeble circulation ensue. In these 
cases, there is literally nothing to be done, but make your patient 
as comfortable as circumstances will allow, and prepare him for 
death. After a time, sloughing of parts below the seat of injury 
commences ; the nates and thighs coming away in great masses. 
The symptoms and results, of course, vary in different cases, and 
in regard to the situation. When the cervical portion is cut, death 
will be almost instantaneous. When in the dorsal region, it will 
very likely be from actual asphyxia, and when in the lumbar 
region, it will be more prolonged, and the sufferings will be greater. 

Caries of the Spine. 

Caries, as a general disease of the bones, will be found more 
fully described in another chapter. When the bones of the spinal 
column are thus affected, the disease does not materially differ 
from the same trouble in other situations, except in its effects. 
The body of one or more of the vertebrae is the seat of the affec- 
tion, the arches or processes being never, or rarely, affected. 
Scrofulous children are those most commonly met with as suffer- 
ing in this way ; indeed, scrofula is, in nearly every case, the pre- 
disposing cause. In people so affected, the posture is generally 
stooping, and on examining the back, the dorsal spine is usually 
found to be the portion so diseased. Here you will find one or 
two prominences which are painful if pressure be made upon them. 
As the disease progresses, the patient becomes more or less hump- 
backed, and his general health becomes impaired ; the extremities 
lose power, partial or complete. Occasionally psoas or lumbar 
abscess precedes caries, and in other cases succeeds it; when 
it precedes the disease of the bone, there is some little chance to 
treat the case so that caries will not be developed. I am inclined 
to think, however, that such an occurrence is rare, and that the 
disease of the bone must make considerable progress before the 
abscess is formed. ♦- 



1 36 Surgical Diseases of the Spine. 

In the treatment of this serious affection, perfect rest and the 
maintenance of a good position are absolute essentials to a good 
result. If pressure be constantly exerted on a vertebra already 
predisposed to caries, by one above it that is still sound, or even 
diseased, caries will be more surely developed in the sound bone ; 
or, if the diseased one be compressed between two sound bones, 
the original malady is increased, and the deformity, so much to be 
dreaded in all cases, will be the more surely developed in such a 
case. Keep your patient quiet, and, if possible, lying down, and 
if he is unable to bear a constant recumbent position in bed, em- 
ploy one of the many good supports found in all our shops. 

Lateral Curvature of the Spine. 

This is a disease, or, more properly speaking, a deformity of 
the spinal column peculiar to women alone, although there have 
been one or two instances of men suffering in that way. The 
cause seems to lie in a want of tone or vigor in the muscles 
and ligaments. Now what is the reason for this loss of power ? 
In many instances, most assuredly, some hereditary or acquired 
taint or cachexia will be found to lie at the bottom of the ques- 
tion, but in by far the largest number of cases, injudicious dress- 
ing, in accordance with the ridiculous claims of " fashion," will be 
found to be the cause. Prominent among these errors of dress 
will be found that " corset" nuisance, which, in the last century, 
furnished so much material for hygienic homiletics. Wrong posi- 
tions in reading, writing and sewing undoubtedly exercise a strong 
influence, but women are more liable to commit these errors than 
men. 

It appears to me useless to attempt the cure of this deformity by 
medicine unaided by mechanical appliances. There is a variety 
of good apparatus, each one possessing advantages in certain cases, 
so that the choice of one must be determined by the peculiarities 
of the case. Remedies are invaluable in restoring the tonicity of 
the muscles and ligaments, when the wrong position has once been 
rectified, but to effect this a great deal of time and patience, on the 
the part of both physician and patient, is required. M. Guerin has 
considered this deformity to be one analogous to club-foot, that is, 
a contraction of one of the sets of muscles, and counsels division 
of them. Modern science has not demonstrated this, but inclines 



Myelitis. 137 

to the opinion that it is a weakening of both sets of muscles and 
ligaments, and that the employment of subcutaneous section is use- 
less. 

Spina Bifida. 

Spina bifida is a disease peculiar to infancy. We find in this 
disease, an opening existing in one or more of the vertebrae, usu- 
ally in the lumbar region, through which there is a protrusion of 
the meninges and fluid of the spinal canal, forming a tumor, oblong 
in shape, compressible, and disappearing on pressure. The pain 
is not severe, but if the patient live to adult age, the health will be 
more or less impaired from its existence. 

My course of treatment would be, to keep up continuous pres- 
sure on the mass, so that it be all returned into the cavity of the 
spinal canal, and then endeavor to procure a natural closure of the 
opening by the use of appropriate remedies. 

Myelitis. 

Inflammation of the spinal cord is the common result of inju- 
ries inflicted on the spine, involving the cord ; it may also occur 
idiopathically, or follow some other disease. A jar, produced by 
falling on the feet from a height, will, in some instances, produce 
it. The gravity of .the disease varies according to the extent of 
the injury, and even in slight cases, if allowed to go on unchecked, 
will eventuate in a softening of the cord, and consequently death. 
It is curable, however, but the closest attention must be given to 
the case. The diagnosis is sufficiently easy ; in the first place, any 
injury to the spine is apparent at once, and myelitis may be ex- 
pected to ensue to a certainty, so when the following symptoms 
occur, you may know at once the nature of the trouble. When its 
origin is not traumatic, the diagnosis is not so easy, but a little care 
will show you the true nature of the trouble. The symptoms of 
this affection are indicated by pain, more or less severe, in some 
cases of an intermittent character, either confined to the lumbar, 
dorsal, or cervical region, or embracing the entire length of the 
spine. The pain is aggravated by the slightest movement, and an 
exalted sensibility of various parts of the cutaneous surface is 
often perceptible from the dread and shrinking which the patient 
exhibits at the slightest touch. Sharp pam at the epigastrium, 
6 



138 Surgical Diseases of the Spine. 

sometimes spreading over the whole of the abdominal region, and 
increased on pressure : palpitation of the heart, sensation of con- 
striction and weight in the forepart of the chest, with oppressed 
respiration; and small, quick, hard pulse. When the inflammation 
occupies only 2, part oi the cord, the symptoms vary according to 
its locality. Thus, when the commencement, or the cervical por- 
tion, is principally affected, strabismus, spasms of the pharynx, 
trismus, with loss of voice, spasm, or other abnormal conditions of 
the muscles of the neck, chest, and superior extremities, with gen- 
eral clonic convulsions, declare themselves. When the dorsal por- 
tion of the cord is the seat of inflammation, opisthotonos usually 
results ; and when that of the lumbar is attacked, retention of 
urine, or paralytic or spasmodic affections of the pelvic viscera 
generally, are met with. In each of the latter cases, the inferior 
extremities are commonly convulsed or paralyzed. When the 
membranes are affected, the sensibility of the surface is increased, 
and the spasms tonic ; the bowels also are generally constipated. 
When the substa?ice of the cord itself is inflamed, cutaneous sensi- 
bility is affected but little, rather lower than common ; the spasms 
are clonic, and there is diarrhoea. 

The terminations may be : softening, induration, suppuration 
gangrene, or in effusions of serum, pus or blood. 

Therapeutics. — The remedies employed for the foregoing 
diseases are as follows : Aeon., August., Am., Ars., Bell., Bry., 
Calc c., Calc. phos., Con., Dig., Dulc, Hep., Ign., lod., Lack., Lye., 
Merc, Nux v., Opt., Phos., Plwnb., Puis., Rhus, Sil., Sir am., 
Sulph., Verat., Zinc. 

They may be classified in the following order : 
Caries of the Spine : Ang., Bell., Calc, lod., Lye, Merc, Puis., 

Rhus, Sil., Sulph., Ars., Hep. 
Lateral Curvature : Calc, Puis., Sil., Sulph., Lye, Plumb., 

Rhus. 
Spina Bifida : Calc c, Calc. p., lod., Phos., Sulph. 
Myelitis: Aeon., Am., Ars., Bell., Bry., Con., Dig., Dulc, JLyos., 
Lgn., Lach., Merc, Nux v., Op., Puis., Rhus t Stram., 
Sulph., Verat., Zinc. 

from a stab : Staph., Stram., Ars., Rhus, Merc. 

from a blow : Am., Merc. 

from a fall : Am., Merc, Op., Rhus. 



Special Therapeutics. 139 

Myelitis: from a fracture: Aeon., Phos. 

from a dislocation : Aeon., Arn., Mere., Rhus; Hyos, 

Aconite nap. Shooting pains; attacks of fainting; stinging 
pains, or a lame and numb feeling in the affected parts ; skin dry 
and burning ; restlessness and nightly delirium ; can not lie still ; 
wants to be sitting up ; apprehensions of death ; momentary par- 
alysis of the anus, with pain in the rectum ; retention of urine, with 
sticking in the region of the kidneys; or, incontinence of urine- 
with profuse sweat, watery diarrhoea and colic; shortness of breath 
when sleeping ; pains in the chest, as if the sides were drawn to- 
gether; painful boring to the left of the lumbar vertebrae; numb- 
ness and lameness of the left thigh; transient paralysis of the 
legs ; coldness of the feet, with sweat on the toes and soles of the 
feet. 

Worse at night; also, on coughing, from lying on the painful 
side, from light in general, after sleeping, and on being touched. 

Better from warmth in general. Left side. 

Angostura. Easily frightened, and starts ; tension in the tem- 
poral muscles when opening the mouth ; the eyelids are spasmodic- 
ally opened; tension in the muscles of the face; lockjaw, with the 
lips drawn back so as to show the teeth ; after the attack the lips 
and cheeks remain blue for some time ; intermitting, spasmodic 
breathing; painful sensitiveness of the chest, even to the slightest 
touch ; twitching and jerking along the back like electric shocks. 
Worse on being touched. Left side. 

Arnica mon. Heaviness in all the limbs; painful lameness of 
the joints ; general sinking of strength, quarrelsome and peevish, 
with a tendency to start; stitches under the false ribs arresting: 
the breath ; sharp thrusts through the abdomen ; frequent small 
stools, consisting only of slime ; tenesmus of the neck of the blad- 
der, with stitches in the urethra; stitching pain in one side of the 
chest, with a sharp cough which increases the pain ; tingling in the 
vertebral column, pricking in the knee when touched. 

Worse in the morning, and at night ; also, on awaking, when 
coughing, when moving, from talking, and on being touched. 

Better when lying down, and from rubbing. Left side. 

Arsenicum alb. Burning in the back ; sensation as if the small 
of the back were bruised ; great emaciation and debility ; weakness 
of the small of the back ; pains in the back, with uneasiness and 



140 Surgical Diseases of the Spine. 

anxiety , acute burning in the interior of the spinal column ; diar- 
rhoea, with vomiting ; bloody diarrhoea ; burning in the anus ; par- 
alysis of the bladder ; involuntary micturition ; anxious and 
oppressive shortness of the breath; suffocating oppression and 
arrest of breathing ; stiffness of the nape of the neck ; swelling of 
the neck ; heaviness in the lower limbs ; partial paralysis of the 
lower limbs. 

Worse at night, after midnight, and periodically; also, from 
cold, from exertion of the body, when lying on the back, and after 
lying down. 

Better when lying with the head high, and from warmth. Either 
side. 

Belladonna. Intense cramp-pain in the small of the back ; 
cramp-pain in the os coccyx ; he can only sit for a short time ; lan- 
cinations from without inwards in the vertebrae, resembling stabs 
with a knife ; pain as if from a sprain in the right side of the back, 
and in the spinal column ; cramp-like oppressive sensation in the 
middle of the spinal column; paroxysms of stiffness of all the 
limbs, or of single limbs ; fainting fits, sometimes resembling leth- 
argy ; furious delirium, with protruded eyes and dilated pupils ; 
paralysis of the sphincter ani ; involuntary passage of faeces ; con- 
stipation or diarrhoea ; copious and frequent emission of pale, 
clear, watery urine ; labored irregular breathing ; tremor of the 
heart ; perceptible throbbing of the blood vessels ; tremor of the 
knees. 

Worse in the afternoon, evening, and at night ; also, during in- 
spiration, when coughing, on shutting the eyes, from light in gen- 
eral, and when moving. 

Better from opening the eyes, when lying down, and from warmth. 
Right side. 

Bryonia alba. The strength disappears on making the least 
effort ; out of humor and irritable ; burning in the stomach, consti- 
pation obstinate ; hot urine, with burning and cutting previous to 
the emission ; sobbing breathing ; stitches in the chest when lying 
on the back, made worse by every movement ; heat in the chest ; 
pricking pain below the right nipple, from within outwards ; the 
prickings are only felt after an expiration ; drawing down along 
the back. 

Worse in the night ; also, before falling asleep, during inspira- 
tion, from cold, when coughing, while lying on the painless side 
when moving, from talking, on being touched. 



Special Therapeutics. 141 

Better from cold, from lying on the painful side, and after lying 
down. Right side. 

Calcarea Carb. Pain in the small of the back ; pain in the 
small of the back, as if from a sprain in lifting ; easily tired by 
bodily exertions ; talking makes her weak ; stinging and cutting 
pains in the back ; pulsating pains in the small of the back, so 
that he can scarcely rise from his seat after having been seated ; 
cold sensation ; shooting in the lumbar region ; aversion to the 
open air ; sickness at the stomach and great weakness. 

Worse in the morning ; also, in the open air, on bending down, 
in wet weather, and from water, and washing. 

Better while lying on the back, after lying down, and in dry 
weather. Right side. 

Calcarea phos. Violent pain in the small of the back, when 
performing the least bodily effort, sometimes obliging him to 
scream ; frequent transitory chills. 

Worse in the morning; also, upon the warmth of the room, 
from movement, particularly walking, and when stooping. 

CoCClllllS ind. Alternate going to sleep of the feet and the 
hands, in transitory paroxysms ; disposition to tremble ; a slight 
noise causes all the limbs to start ; pinching in the epigastrium 
arresting the breath ; the right side of the chest feels tight and 
constricted, oppressing the breathing; oppression of the chest as 
if from a stone ; drawing, lacerating or boring pain in the back 
paralytic immobility of the lower limbs ; paralysis of the lower 
limbs from the small of the back downwards. 

Worse in the evening; also, on awakening, from cold, from men- 
tal exertion, on moving, and from talking. 

Better from an outward pressure, and from warmth. Right side. 

Digitalis purp. Considerable lassitude ; general weakness with 
fainting fits ; desponding and fearful ; vomiting of the ingesta, or 
of mucus ; violent diarrhoea ; ash-colored diarrhoea, lacerating, and 
sharp stitches in the small of the back; drawing with pressure in 
the nape of the neck ; cutting pain in the neck ; palpitation of the 
heart. 

Worse in the morning ? ; also, after breakfast and after dinner; 
Left side. 

Dulcamara. Lassitude; pains like those brought on by a cold 
dryness, heat, and burning of the skin ; restlessness, delirium at 
night ; nausea and vomiting of mucus ; sensation of inflation at the 



142 Surgical Diseases of the Spine. 

pit of the stomach ; white mucus diarrhoea ; diarrhoea with faint- 
ness ; oppression or tightness of the chest ; pinching, or deep 
cutting pain in the chest ; constrictive pain as if in the muscles of 
the back ; drawing in the muscles of the thigh ; bloatedness and 
swelling of the leg ; burning in the feet. 

Worse in the night ; also, from cold, while lying down, and from 
talking. 

Better from moving, from pressure, and from warmth. Left 
side. 

Hepar SUlph. Pain as if from bruises in the small of the back ; 
a violent pain in the small of the back, as if the joints were being 
cut through during rest, or motion either ; always pains as if from 
bruises in the small of the back and in the lumbar vertebrae ; 
drawing in the whole back ; stitches in the back ; great weakness 
in the whole of the spine. 

Worse in the evening and at night ; also, in the open air, on 
bending down, from cold, on getting heated, on moving, from ex- 
ternal pressure. 

Better while and after lying down, from warmth, and in damp, 
wet weather. Either side. 

HyOSCyamilS nig. Subsultus tendinum ; spasms with coldness 
and diarrhoea ; pinching in the abdomen ; mucus diarrhoea ; ex- 
hausting, debilitating diarrhoea ; retention of the urine, or paraly- 
sis of the bladder ; difficulty of breathing, with stitches in the 
sides of the chest ; pain in the back, stiffness and rigidity of the 
cervical muscles ; coldness and swelling of the feet. 

Worse in the evening; also, when looking at shining objects, 
and when vomiting. 

Better from warmth. Either side. 

Ignatiaamara. Simple pains, which are apt to become exces- 
sive when touched; tingling in the limbs- as if they had gone to 
sleep; jerks through the whole body; single starting of the limbs 
when going to sleep ; brooding, gloomy suspicions ; mucus stool 
with colic ; frequent emission of watery urine ; stitches in the left 
side of the chest; oppression of the chest and breathing; spas- 
modic constriction of the chest ; palpitation of the heart ; stiffen- 
ing of the nape of the neck ; stiffening of the knees and tarsal 
joints. 

Worse in the morning, at night ; also, on awaking, from exertion 
of the mind, when lying down on the painless side, and on being 
touched. 



Special Therapeutics. 1 43 

* 

Better when inhaling and from rubbing. Left side. 

lodilim. Stitches in the small of the back; pains like rheuma- 
tism; glandular swellings ; emaciation with hectic fever ; complete 
prostration of strength. 

Worse in the evening and at night ; also, while lying on the 
back, from pressure, on moving, when walking, from warmth and 
from the heat of the bed. 

Better from cold, after lying down, and while standing. Right 
side. 

LacheSJS. Sudden attacks of vertigo, and trembling of the whole 
body ; lassitude in all the limbs ; loathing of life ; hurriedness and 
uneasiness ; nausea, and inclination to vomit ; vomiting with 
diarrhoea; gnawing in the stomach; pain across the stomach as if 
diarrhoea would set in ; cutting or beating in the abdomen ; alter- 
nate looseness and costiveness of the bowels ; urging to micturi- 
tion, with copious discharges of foaming urine ; tightness of 
breathing ; oppression of the chest ; suffocative fits ; stitches and 
palpitation of the heart ; pain in the small of the back ; stitches 
in the back ; sensation of sinking in the back ; swelling of the 
lower extremities, knees, legs and feet. 

Worse in the evening; also, from pressure, and after the stool. 

Better while inhaling. Right side. 

LyCOpodilim. Sudden failing of strength ; great weakness ; 
great thinness , pain in the small of the back ; stiffness or aching 
in the small of the back ; drawing pain in the small of the back ; 
feeling in the small of the back, as if the flesh were loose ; chilli- 
ness in the small of the back ; large swelling of the psoas muscle, 
very painful on moving the body ; pain in the back extending to 
the shoulders and small of the back ; rheumatic tension in the 
back ; pinching in the back ; drawing pain in the back ; burning 
as if from a red hot coal between the scapulae. 

Worse in the afternoon, evening, and at night ; also, in the open 
air, in cold and wet weather, from exertion of the body, while and 
after lying down, on beginning to move, from pressure, while sit- 
ting, from warmth in general, and from the heat of the bed. 

Better while lying on the back, when moving, when walking in 
the open air, and in dry weather. Right side. 

MercurillS. Griping pain in the small of the back; bruised 
pain in the small of the back ; (the former is felt more when stand- 
ing, and the last when sitting) ; sharp pricking in the dorsal spine ; 



144 Surgical Diseases of the Spine. 

bruised pain in the whole back ; burning between the shoulders, 
and down the back ; swollen and stiff neck, with difficulty in turn- 
ing the head ; sinking, with indescribable malaise of body and 
mind ; paroxysms of spasmodic contraction in the limbs ; rigidity 
and immobility of all the limbs ; sweat at every motion ; copious 
perspiration at night, but which does not afford any relief; exces- 
sive indifference to everything; complete jaundice; nausea with 
diarrhoea; shortness of breath, with a burning sensation in the 
chest ; violent bruised pain across the chest. 

Worse in the evening, and at night ; also, while lying on the side, 
from moving, and from the heat of the bed. 

Better from cold, on going to sleep, and from rubbing. Either 
side. 

NlIX Vomica. Trembling in the lower limbs and stiffness; lan- 
guor in all the limbs and dread of motion ; great nervous weakness, 
with excessive irritation of all the senses, particularly sight, and 
hearing ; nausea early in the morning ; vomiting of sour tasting 
and smelling mucus ; constipation, or corroding diarrhoea ; draw- 
ing, burning, lacerating, or bruised pains in the back; paralysis of 
the lower extremities and bladder. 

Worse in the morning; also, on awaking, on getting cold, from 
mental exertion, while lying on the back or painful side, on mov- 
ing, from being touched. 

Better on awaking, while lying on the painless side, after lying 
down, after sleeping, and from warmth. Right side. 

Opium. Numbness and insensibility of the limbs ; trembling, 
convulsions, or spasmodic jerkings of the limbs ; rigidity of the 
body ; fretfulness and tendency to start ; stupor ; constrictive pain 
in the stomach ; nausea and inclination to vomit ; costiveness ; 
paralysis of the intestines ; sometimes involuntary stools ; suppres- 
sion of urine ; stertorious respiration ; irregular breathing ; draw- 
ing, lacerating in the back ; weakness and violent itching of the 
lower limbs ; numbness and swelling of the feet. 

Worse at night ; also, on rising, and before the stool. 

Better ? Right side. 

Phosphorus. Pain in the small of the back, when rising after 
stooping; pain as if the back were broken; paralytic weakness of 
the small of the back ; sick and paralytic feeling in the body, 

Worse in the morning, forenoon, evening, and at night ; also, 
when lying on the back, or left side, during and after morning, 
when walking, and when the weather changes. 



Special Therapeutics. 145 

Better in the open air, when lying down on the right side, when 
rubbing, when standing. Right side. 

Plumbum acet. The indications for this remedy are not many, 
but it has quite a reputation in spina-bifida and caries. Quiet and 
melancholy mood ; constipation with vomiting of faeces ; painful 
foetid diarrhoea of yellowish faeces , stitches in the chest and sides ; 
anxiety about the heart, and violent palpitation ; paralysis of the 
limbs. 

Worse at night. 

Better from rubbing. Right side 

Pulsatilla. Aching pain in the small of the back, as if weary; 
stiffness and pain in the small of the back when lying, as if from 
subcutaneous ulceration ; pain as if dislocated during motion ; 
lacerating pain in the back; sticking pain in the backhand across 
the chest; interstitial distension and curvature of the upper dorsal 
vertebrae ; excessive debility, and bruised feeling in the limbs ; 
painful feeling of lameness in the ligaments ; tremulous weakness; 
gloomy and melancholy ; peevishness ; aching drawing pain in 
the pit of the stomach, only in the morning ; gripings, and pain- 
ful sensitiveness of the abdominal walls ; evacuations consisting 
of nothing but mucus mixed with blood ; loose acrid stools in the 
mornings ; frequent desire to urinate, with drawing in the abdo- 
men. 

Worse in the evening and at night ; also, from warmth, while 
lying down on the painless side. 

Better from cold, and when in the open air. Right side. 

Rhus foxJCOd. Numbness and stiffness of the limbs ; great 
debility, and sudden paroxysms of fainting; sensation as if the pit 
of the stomach were swollen, impeding respiration ; violent throb- 
bings below the pit of the stomach ; tightness of breath, and con- 
tractive sensation in the chest ; sticking in the region of the heart ; 
tingling pains in the back ; pain in the small of the back ; creep- 
ing in, and coldness of, the back ; pain in the small of the back as 
if it were bruised ; painful bony swelling in the small of the back ; 
pain as if sprained in the back and shoulders ; curvature of the 
dorsal vertebrae. 

Worse in the morning, evening, and at night ; also from cold, in 
cold and wet weather, from exertion of the body, on beginning to 
move, while lying on the back, and after lying down. 



146 Surgical Diseases of the Spine. 

Better from warmth, while moving, while lying down, while walk- 
ing, and in dry weather. Right side. 

SNicea. Violent pain in the small of the back, of a spasmodic 
drawing character ; stiff back after sitting ; lacerating and sticking 
in the back; inflamed psoas abscess; swelling and curvature of 
the vertebrae ; severe bone pains, now here, now there ; deadness 
and heaviness of the lower limbs 

Worse in the afternoon, evening, and at night ; also, on bending 
down, from exertion of the body, and when lying on the back ; 
also, on beginning to move, and on pressure. 

Better while lying down, and from warmth. Right side. 

Stramonium. Loss of the special senses; loss of involuntary 
motion : stiffness of the whole body * paralysis of the lower limbs, 
bladder, and intestines ; frightful convulsions at the sight of a 
candle ; convulsions on looking at a bright light ; anxiety about 
the pit of the stomach , rumbling in the abdomen ; drawing pain 
in the small of the back. 

Worse in the morning ; also, from the light of a candle, or from 
looking at a shining object, and from being touched. 

Better after lying down. Left side. 

SulDJllir. Pulsative stitches in the region of the loins and of 
the kidneys ; pain above the small of the back ; painful stiffness 
of the small of the back ; pain in the small of the back when ris- 
ing from a seat ; drawing pain in the small of the back ; sensation 
as if the vertebrae were gliding one over the other during motion 
in bed ; burning, and biting in the back ; frequent spasmodic jerk- 
ing in the whole body; talking fatigues and excites the pains; 
desponding ; disposition to weep ; out of humor, irritated ; taci- 
turn ; nausea, and sour vomiting ; vomiting of the ingesta ; feeling 
of coldness in the region of the stomach ; stool consists of undi- 
gested food, or is mucous, or slimy ; nightly suffocative fits, with 
rattling in the chest, relieved by expectoration. 

Worse in the evening, and at night ; also, on awakening, while 
drawing the breath, while lying on the side, from talking, on being 
touched. 

Better on getting cold, and from rubbing. Left side. 

Veratrum album. Paralytic weakness' of the limbs, as after 
fatigue; anxiety; vomiting of the ingesta, with green mucus; 
vomiting followed by extreme weakness ; violent pressure in the 
pit of the stomach ; diarrhoea with great exhaustion ; aching pain 



Special Therapeutics. 147 

under the sternum ; excessive anguish, arresting the breathing ; 
palpitation of the heart, with anxiety, and hurried, audible breath- 
ing ; pain and stiffness along the whole of the back ; painful heavi- 
ness of the legs, as if from extreme fatigue ; icy coldness of the 
feet. 

Worse in the morning ; also, on coughing, after the sleep, from 
talking, and from being touched. 

Better on getting cold. Right side. 

ZillCUm met. Desponding and sad ; pressure in the pit of the 
stomach ; hard pressure in the sides of the abdomen, hypochon- 
dria and back; dry, insufficient stool ; burning at the anus; anx- 
iety in the chest, with tension here and there in the left breast ; 
burning in the chest ; frequent palpitation of the heart, but without 
any anxiety ; violent tensive pain in the lumbar region, like rheum- 
atism. 

Worse in the afternoon and evening ; also, in a warm room. 

Better in the open air. Left side. 

Operations. 

There are no mechanical proceedures in the treatment of these 
diseases or deformities, that promise sufficient success to induce 
one to attempt it. The sub-cutaneous section in lateral curvature, 
has been shown to have been performed under a mistaken notion 
of the pathological condition. In spina-biflda, some puncture, 
some ligate, and some employ simple pressure. Should it become 
necessary to resort to any means outside of our therapia, I should 
employ pressure ; in the event of that failing, ligation, but under 
no circumstances would I puncture. I should expect to see My- 
elitis follow such a proceedure. 



SURGICAL DISEASES OF THE ABDOMEN, 



Injuries to the Abdomen — Injuries to the Pelvic Viscera 

Injuries to the Abdomen 

may be contusions, non-penetrating, and penetrating wounds. 

Simple contusion, if severe, may be attended with laceration of 
some of the viscera, or inflammation, such as peritonitis: Some 
of these lacerations are very difficult to diagnose, therefore, the 
amount of injury sustained by any internal organ, is far from easy 
to learn. Indeed in all cases, unless the contusion is accompanied 
by a wound, you cannot tell whether there is a rupture, unless the 
organ be one whose functions are so very prominent that a change 
from their proper performance gives the clue. Even here, there is 
a considerable amount of obscurity, as the blow, or the resulting 
inflammation are just as likely to change the natural performance 
of their functions, as an actual rupture. Pain, or a sense of a 
weight follows a blow, in some particular locality, and there may 
be a simple congestion or a rupture; in either case the functions 
are more or less imperfectly performed ; and though a positive diag- 
nosis is almost impossible, yet this at least tells us which organ is 
affected. The stomach is often lacerated, and the accident is gen- 
erally indicated by a vomiting of blood ; but even this does not 
positively indicate such an accident. The kidneys show the injury 
by an emission of blood, pure or mixed with urine, and a frequent 
desire to micturate ; although the same conditions occur in lacera- 
tion of the bladder. In accidents such as these, diagnosis is very 
important to homceopathists. It is only in diseases without any 
injury, that it seems superfluous. Use every exertion to find out 
the nature and extent of the lesion, if, for nothing else, to tell the 



Injuries to the Pelvic Viscera. 149 

patient's family or friends the prospect of recovery. But unless 
the patient dies, and an autopsy is held, there can be nothing 
positive. 

Emphysema is a frequent occurrence when the intestines are 
torn. The symptoms are much the same as in thoracic emphy- 
sema, and may exist with or without a wound. The intestines 
may be torn by the blow, and the flatus escape into the sub-peri- 
toneal cellular tissue, and thence into the more sub-cutaneous 
tissues, giving rise to this condition. 

Non-penetrating wounds, are those in which the skin, and one or 
more of the underlying muscles is cut, leaving the innermost layer 
entire. The treatment employed in similar wounds in other situ- 
ations, is suitable here. Proper position, so that the muscles may 
be relaxed, will prove of much benefit. 

Penetrating wounds, with or without intestinal protrusion, call 
for prompt treatment, early closure, and the usual remedies in 
such cases. When the intestine protrudes, it must be returned as 
gently as possible, with little handling, and the wound after being 
closed covered by light compress. When the intestine is wounded, 
it must be sewed up with a " glover's" or continuous stitch, and 
returned. The danger of subsequent peritonitis is greater in these 
cases than in any other. 

Injuries to the Pelvic Viscera. 

Injuries of the Pelvic Viscera include, rupture of the bladder, 
foreign bodies in the bladder, lacerated urethra, lacerated perineum, 
and foreign bodies in the urethra and vagina. 

Rupture of the Bladder, is quite easily told, particularly if it had 
been distended at the time ; the symptoms would then be, collapse 
of that viscus, severe burning pain in the pelvis, inability to pass 
urine, or a very little bloody water may be emitted. If the cathe- 
ter is now introduced it will be found that the bladder is empty. 
I do not think it possible for any greater calamity to befall a man 
than this ; there is consequent extravasation of urine into the 
cavity of the pelvis, which as urine is poisonous to all living 
tissues save its proper membranes, is sure to be followed by very 
serious results. Peritonitis of the worst kind, a very serious 
inflammation, with sloughing and suppuration, are among the 
sequelae. The treatment consists, in passing a catheter of the 



150 Surgical Diseases of the Abdomen. 

largest calibre that the urethra can accommodate, and retaining it 
in place by tapes, so that urine may pass off as quickly as it is 
secreted. Arnica, given internally, and a watery solution of the 
3d attenuation, injected into the bladder through the catheter, will 
be of service. Sometimes this treatment will prevent all further 
mischief. 

Foreign bodies in the Bladder, are to be removed at once. Child- 
ren in play and young people of more advanced age, often intro- 
duce such substances as lead or slate pencils into this canal ; they 
are usually those who are confirmed masturbators. Soldiers have 
been wounded in the abdomen, the ball entering and remaining in 
the bladder. When the body is small, the urethral forceps will 
probably be all-sufficient to remove it. But when large, as a mus- 
ket ball, it is necessary to open the bladder as in the operation for 
lithotomy. Inflammation, suppuration, consequent perforation, and 
occasionally sloughing are among the effects of these accidents. 
When the walls of the bladder are perforated, the same treatment 
is called for as in rupture of that viscus. 

Laceration of the Urethra: Blows, such as a kick, or fall from a 
height, as often happens to house builders, cause this accident in 
the majority of cases. The principal danger in this injury, is 
the infiltration of urine into the tissues of the perineum, giving 
rise to abscess. Under bad management, as in irregular treat- 
ment, the remote effects of these injuries are disastrous in the 
in the extreme. Even if spared from death in consequence of the 
extensive suppuration, the patient will probably be left with an 
impermeable stricture, or a fistulous opening in the perineum. By 
an early incision this fistula may be avoided. As in other injuries 
which admit of this urinary effusion, a catheter must be used, and 
retained permanently. The laceration may be so extensive, that 
the catheter cannot be passed. Then the bladder must be emp- 
tied with a curved trocar, through the rectum, or anteriorily. 
Arnica, topically and internally is the best treatment, if not the 
only admissable one. Watch the case carefully, and if any signs of 
suppuration are seen, open the abscess freely and promptly, other- 
wise as said before, a fistula will be formed in the perineum, which 
is at least unpleasant. 

Laceration of the Perineum. This is an accident rarely seen 
except in cases of labor. The laceration may be to almost any 
extent, from one of but little depth to an inch long, to one involv- 



Special Therapeutics. 151 

ing the vagina, and extending to the anus. The treatment is 
almost entirely mechanical. Cases have recovered by placing the 
patient on the side and strictly enjoining quiet for two or three 
weeks. 

Foreign bodies in the Vagina are met in girls who are confirmed 
masturbators. The list of articles which have been removed from 
such a position by the surgeon, is a large one, and embraces nearly 
every conceivable thing. The extraction is often attended with 
considerable difficulty, owing to the swelling of the parts, as well 
as the pain consequent upon the inflammation. A dose or two of 
Aconite, will usually reduce this, when with a pair of lithotomy 
forceps, the substance may be extracted. Arnica, topically and 
internally, will be the remedy required after the removal. 

Therapeutics of the different complications that may arise, 
will of necessity be suppositious here ; although the remedies 
and symptoms given are those that have been oftenest noticed 
by me. 
Peritonitis : Aeon., Arn., Ars., Bell., Bry., Cham., Coff., Coloc, 

Hyos., Nux v., Opi. 7 Rhus. 
Inflammation of the Intestines: Aeon., Am., Ars., Bell., Bry., 

Cham., Hyos., Ipec., Lach., Nux v., Puis., Rhus. 
Gangrene of the Intestines : Ars., Lach., Nux v., Rhus. 
Inflammation of the Bladder : Aeon., Am., Ars., Bell., Canth., 

Calc, Graph., Zyc. } Merc, Sulph., Puis. 
Gangrene of the Bladder : Am., Ars ., Canth., Puis. 

Aconite nap. Painful feeling of swelling in the stomach, with 
want of appetite, and paroxysms of shortness of breath; pressure 
in the region of the liver ; burning in the umbilical region ; the 
abdomen is sensitive to the touch ; diarrhoea, with nausea and 
sweat ; frequent, scanty, and loose stool with tenesmus , watery 
diarrhoea, white stools and red urine , involuntary micturition ; 
urging to urinate. 

Worse morning, evening, and night ; also, before stool, after 
stool, while urinating. 

Better while lying on the back or on the sound side. Left side. 

Arnica mon. Feeling of repletion in the stomach, although he 
has eaten nothing, accompanied by a loathing of food ; stitches 
under the false ribs arresting the breath ; colic resembling dysen- 
tery ; sharp thrusts in the abdomen from one side to the other ; 



152 Surgical Diseases of the Abdomen. 

hard difficult stool with pressure in the abdomen ; frequent small 
stools consisting only of slime ; constipation ; bloody urine. 

Worse in the morning, evening and night ; also, on moving the 
body, before and after urinating. 

Better when lying down on the sound side. Right side. 

Arsenic alb. Pains in the whole abdomen, excessive at night; 
pains with the greatest anguish, lamentations, tossing about and 
internal restlessness which does not allow one to lie still ; despair 
of life ; spasmodic pains in the abdomen , feeling as if the intes- 
tines were twisted ; cutting in the abdomen , writhing sensation in 
the abdomen ; cold, or burning sensation in the bowels ; painful 
distension and swelling ; constipation with pain in the abdomen ; 
tenesmus with burning and pressing in the anus and rectum ; vio- 
lent diarrhoea, with frequent discharges ; also, tenesmus, colic, 
vomiting, and great weakness ; evacuations are yellow and burn- 
ing, or dark green and slimy ; black, burning, or acrid, or undi- 
gested stools ; dysenteric diarrhoea ; discharges of blood with the 
urine. 

Worse at night ; also, when eating, while lying on the back, or 
injured side, after lying down, and during stool. 

Better when awaking, and when lying on the sound side. Right 
side. 

Belladonna. Distended, but neither hard nor painful abdomen ; 
colic, with a sensation of drawing, griping, seizing, or clutching 
as if with fingers or claws ; contractive dragging in the umbilical 
region ; flatulent colic ; heat and anxiety in the abdomen ; violent 
incisive pressure in the hypogastrium ; shuddering during stool ; 
little or no stool, but great straining ; diarrhoeic stool with great 
tenesmus ; also dysenteric stool ; vomiting after tenesmus ; consti- 
pation with pressure, and contractive pain in the rectum ; invol- 
untary discharge of faeces. 

Worse in the afternoon, evening, and at night ; also, on moving, 
on being touched, when turning, from talking, and after urinat- 
ing. 

Better when lying down and afterwards. Left side. 

Bryonia. Constipation ; hard, tough stool, with protrusion of 
the rectum; dry stool as if burnt; sensation of swelling in the 
pit of the stomach ; burning, inflammation, and spasms of the 
stomach ; stinging in the region of the liver ; inflammation of the 
liver ; pain in the abdomen which renders the breathing difficult, 



Special Therapeutics. 153 

temporarily relieved by walking ; constipation with feeling as if 
something had lodged in the stomach or bowels ; diarrhoea with 
weakness. 

Worse in the afternoon, and night before midnight; also, just 
before falling asleep, after eating, from motion of the body, lying 
on the sound side, when talking, while turning, and before urinat- 
ing. 

Better while lying on the back, or injured side, and after lying 
down. Left side. 

Calcarea Carb. Constipation with stools like clay or painless 
diarrhoea ; frequent emissions of urine, mixed with mucus. 

Worse in the morning, evening, and at night * also, before, dur- 
ing, and after eating, lying on the sound side, during and after 
stool, talking, and after urinating. 

Better when lying on the injured side, after lying down Left 
side. 

Cantharides. Violent burning pain in the stomach ; the stomach 
is sensitive to the touch; inflammation of the liver, diarrhoea of 
mucus, followed by pain in the abdomen, or bloody discharges ; 
during stool, burning in the anus, and prolapsus recti ; after stool, 
chilliness and tenesmus; difficult discharge of deep-red urine; 
ineffectual urging, but a drop at a time ; urine mixed with blood, 
mucus or pus. 

Worse in the afternoon and at night ; also, after the stool, during 
and after urinating. 

Better while lying down, and after lying down. Right side. 

Chamomilla. Painful bloatedness of the epigastrium ; incarce- 
ration of flatulence with pressure upwards ; oppression of the 
stomach as if a stone were passing downwards ; spasms of the 
stomach, particularly after a meal and at night ; continuous tensive 
pain in the sub-costal region ; pressing toward the abdominal 
ring as if a hernia would come down ; painless green, watery diar- 
rhoea ; hot diarrhceic stool ; nightly diarrhoea ; a diarrhceic stool, 
consisting of white mucus, and colic. 

Worse in the evening, and at night ; also, during and after lying 
down, during and after eating, before and during stool, and from 
pressure. 

Better while lying on the injured side. Left side mostly. 

CofFea Cruda. Fermentation in the abdomen, followed by vom- 
iting; dartings in the side of the abdomen, during every expira 



154 Surgical Diseases of the Abdomen. 

tion; diarrhoea, with warmth and a slight sensation of roughness 
at the anus. 

Worse in the morning ; also, on moving, and during stool. 

Better on lying down ? . Either side. 

ColOCynthis. Exceedingly violent pains, with a sensation of 
drawing or pinching ; or cutting and lancinating as from knives ; 
great tenderness of the abdomen, which feels as if it were bruised ; 
distension, or a feeling of emptiness in the abdomen ; cramps in 
the calves of the legs, or shivering and tearing in them ; excessive 
restlessness, agitation and tossing, caused by the violence of the 
pain; absence of evacuations, or diarrhoea and bilious vomiting, 
which is renewed immediately after eating, no matter how little. 

Worse in the afternoon and evening; also, when lying on the 
back, during stool, and before and after urinating. 

Better when lying on the injured side, and moving. Right 
side. 

Graphites. After eating the stomach becomes inflated ; full- 
ness and heaviness in the abdomen ; distended abdomen with 
diarrhoea ; hardness of abdomen ; constipation ; the stools hard 
and knotty, and connected together by mucus threads ; of too 
large a size ; a quantity of white mucus is expelled with each 
stool ; mucous diarrhoea ; sour-smelling stool, with burning at the 
rectum ; itching and sore feeling at the anus ; anxious, painful 
desire to urinate, with discharge of small quantities of brown 
urine in drops, with a stitch in the urethra when emitting it, urine 
smells sour; very turbid, with a reddish sediment. 

Worse at night ; also, from cold. 

Better when eructing flatus. Left side. 

Hepar Slllph. Bruised, drawing, or cutting pain in the abdo- 
men ; constipation, with stools like clay ; whitish stools ; painless 
diarrhoea ; deep red urine, mixed with blood, mucus, or pus. 

Worse nearly all times of day alike ; also, while eating, while 
lying on the painful side, on movement, on pressure, during stool, 
from talking, on being touched, while turning, while, and after 
urinating. 

Better while lying on the sound side, and after lying down. Left 
side principally. 

Ipecacuanha. Horrible indescribable pain, and sick feeling in 
the stomach ; cutting and pinching, as if grasping with hands 
around the umbilicus ; diarrhoeic stools, green as grass, with nausea 



Special Therapeutics. 1 5 5 

and colic, and as, if fermented ; faeces covered with bloody mucus ; 
bloody stools ; stools smell putrid ; scanty urine, dark red ; unsuc- 
cessful urging to urinate ; hcematuria, with cutting in the abdomen, 
and in the urethra; turbid urine, with brick-dust sediment. 

Worse in the evening ; also, on awaking, on moving, during 
stool, from vomiting, and while urinating. 

Better on awaking ? Right side. 

LaCH8Sis. Burning or cutting pain in the abdomen ; disten- 
sion of the abdomen ; drawing or lacerating pain, with a feeling 
of emptiness; constipation, alternating with diarrhoea; diarrhoea 
with nausea and tenesmus. 

Worse in the evening, and at night ; also, after the stool. 

Better after eating, and when lying down in bed. Right side, 

Lycopodilim. Burning, cutting, or drawing pain in the abdo- 
men ; distension of the abdomen ; frequent emissions of deep-red 
urine, mixed with blood, urgency to urinate. 

Worse in the afternoon, in the evening, and at night; also, just 
before falling asleep, during eating, from moving the body, lying 
down in bed, from pressure, on being touched, from vomiting, and 
while urinating. 

Better when lying on the back, and from motion. Right side. 

MerCUrillS SOl. Constipation, with brownish, greenish, or yel- 
lowish stools ; sensation as if something alive were in the abdo- 
men ; painful diarrhoea, with excoriation of the anus, nausea, tenes- 
mus, and weakness. 

Worse in the night ; also before falling asleep ? , on awaking, from 
moving, before stool, while, and after urinating. 

Better on falling asleep. Right side. 

NlIX VOITI. Obstinate constipation, or hard and difficult faeces ; 
pressure in the abdomen as if from a stone, and sensation of in- 
ternal heat; pinching, drawing, contractive, or compressive pains 
in the abdomen ; pressure at the pit of the stomach, with disten- 
sion of the abdomen, and pain and tenderness ; frequent emission 
of bloody mucus urine, or mixed with pus ; ineffectual urging to 
urinate. 

Worse in the morning, and in the afternoon ; also, on awaking, 
after eating, while lying on the back or injured side, on moving, 
during and after stool, on being touched, vomiting, and before and 
after urinating. 



156 Surgical Diseases of the Abdomen, 

Better while lying on the sound side, and after lying down. 
Either right or left side. 

Opium. Constrictive, intolerable pain in the stomach, causing 
a deadly anguish ; drawing colic ; pain as if the intestines were 
being cut to pieces ; paralysis of the intestines ; costiveness for 
weeks, hard stool ; nothing but small hard balls are passed ; liquid 
and frothy stools ; with itching and burning in the anus, with te- 
nesmus ; involuntary stools ; an excessive pain in the anus. 

Worse in the night ; also, before the stool. 

Better ? . Left side. 

Pulsatilla. Bruised, or cutting pain in the abdomen, with dis- 
tension; constipation with whitish faeces; diarrhoea with shivering ; 
involuntary emission, of a diminished quantity of urine ; urgent 
inclination to micturate. 

Worse in the afternoon, evening, and at night ; also, before fall- 
ing asleep, on awaking, during and after eating, while lying on the 
sound side, after lying down, before the stool, on being touched, 
from vomiting, before, during, and after urinating. 

Better after eating, when lying on the injured side, and from 
moving. Left side. 

Rhus tOX. Pressure in the pit of the stomach as if swollen, 
impeding respiration ; violent throbbing and ulcerative pain below 
the pit of the stomach ; constant tenesmus ; alternate constipation 
and diarrhoea. 

Worse in the morning, evening, and night ; also, after eating, 
when lying on the back, or sound side, after lying down, before 
and during the stool, from talking, on being touched, when turning, 
and before urinating. 

Better from moving, and on pressure. Right side. 

Sulphur. Digging in the abdomen; constipation, with black, 
brownish, greenish, or whitish faeces ; painful diarrhoea, with shiv- 
ering, and weakness : involuntary emission of dark-red, bloody, or 
mucus urine , diminished secretion, with urgent inclination to 
urinate. 

Worse in the evening and at night ; also, before falling asleep, 
after lying down, during and after stool, from talking, on being 
touched, on vomiting, and before, during, and after urinating. 

Better from cold. Left side. 



Special Therapeutics. 



157 



Operations. 



The operations for the relief of these affections, are few and com- 
paratively simple. Among all our remedies we have not one, that 
has at all satisfied me, will produce complete quietness of the 
bowels, so important a point in the treatment of these diseases. 
Quietness we must have, and using it as a sort of a plug — , we 
must resort to opium. Although a rigid Hahnemannian, I must ac- 
knowledge, that this drug must be used, in order to ensure a per- 
fect cure, particularly in lacerated perineum. 

Lacerated urethra ; The instruments needed are, a scalpel, 
probe, and sharp-pointed bistourys ; and for puncture, a curved 
trocar and canula. Should the laceration be so extensive, that the 
catheter cannot be entered into the bladder, make an incision 
through the perineum, and insert the catheter as in lithotomy. 
Should this not be practicable, push the trocar into the bladder 
through the rectum. The former operation is preferable. 

Lacerated perineum: The instruments required, are a scalpel, 
dissecting forceps, needles, silver wire, etc. Carefully clean the 
wound, and if of long standing, freshen the edges with the scalpel. 
The quilled suture may be used, but the " shot-and-button" plan 
is the best. Place the patient in the position for lithotomy, and 
introduce sutures of silver wire; draw the edges of the fissure 
together ; pass the ends of the wire through two holes in the but- 
ton, and fasten them by squeezing split shot together. Introduce 
a catheter, retain it in place with tapes ; ensure absence of evacu- 
ations, and enjoin perfect quietness, and a light diet. The knees had 
best be bandaged together, and the wound dressed by a nurse 
daily with a weak solution of Staph. Other symptoms as they 
arise, are to be met by appropriate remedies, and if care is exercised, 
there is no good reason, outside of some cachexia, why the recov- 
ery should not be complete. 



SURGICAL DISEASES OF THE INTES- 
TINES. 



Hernia — Intestinal Obstructions. 

Hernia. 

This subject is one that would fill quite a large volume. The 
term applies to the protrusion of any of the viscera, either into 
another cavity, or through an opening in the walls of the cavity in 
which they are contained. 

Abdominal hernia, is the protrusion of intestines, or omentum, 
or both, either through one of the abdominal rings, or some other 
artificial opening. These protrusions are dependent upon the 
giving way of the parietes, that have been weakened by disease, or 
have been insufficient from birth, or they may be ruptured from di- 
rect violence. We have two grand classes of hernia, one called 
reducible, when it can be readily returned to the cavity of the abdo- 
men, and the other irreducible, when reduction is impossible. 
This strangulation may be due to one of two conditions, ist. 
When the hernia is of long-standing, the continuance of the press- 
ure exerted by the gut ; a formation of plastic bands, that by narrow- 
ing the opening, or by direct attachment to the gut or omentum, 
prevents its return into the cavity of the abdomen. 2d. A con- 
striction — spasmodic or organic, may be the cause. 

The varieties of abdominal hernia are very many, and as the 
slightest deviation in the descent of the intestine from some au- 
thentic direction is sufficient to give us a new name, with some 
surgeons, the nomenclature alone has deterred many from investi- 
gating the subject. The usually recognized varieties are as follows : 

Inguinal hernia : This is a hernial tumor that issues from the 
inguinal canal, and is known as either direct or oblique. Direct, 
is the term given to it, when it does not issue from the external 



Hernia. 159 

ring, but is merely pushed out through the internal, forcing the 
muscles in front of it. In the words of Erichsen, " the whole ex- 
tent of the canal is not filled up." Oblique is the term, applied to 
that form in which the whole extent of the canal is filled up, the 
gut issuing from the external ring. When the intestine descends 
into the scrotum, it is called scrotal hernia, but is, in reality, only 
an aggravated case of oblique inguinal. This form is the hardest 
to cure, as it is usually of long standing. 

Femoral hernia, is that variety in which the intestines pass out 
under the Pouparts ligament, and consequently occupies the 
sheath, and follows the course of the femoral vessels. 

Umbilical hernia is. as its name indicates, a protrusion through 
the umbilical opening. It is common in children, and among 
adults it is oftener met with among women than men. 

Ventral hernia, is a protrusion of the tumor through other por- 
tions of the abdominal walls, where there is no natural opening, 
and is due generally to violence, by which some of the muscles 
are torn. It is sometimes produced during parturition. It is 
in old age sometimes due to fatty degeneration of the muscular 
walls. 

There are other varieties, but as they are modifications of the 
ones mentioned, the mere mention of their names will be sufficient. 
Thus we have, the sciatic, pudendal, vaginal, peraneal, diaphragma- 
tic, etc. 

Hernia is known by different general names, according to the 
contents of the sac. Thus, when the gut alone has come down, 
we call it enterocelej when the omentum alone, epiplocelej when 
composed of both together, enter o-epiplocele. These may be dis- 
tinguished from each other, when reducible, by the peculiar sound 
emitted on their reduction. The epiplocele slides back quietly, 
the enterocele with a gurgling noise, as if of water running in the 
intestines. 

In operating for incarcerated hernia, the coverings to the prolapsed 
intestine should be well known. In general they may be said to 
be, 1 st, the skin, muscles, and fasciae; 2d, the sac; 3d, the omen- 
tum or intestine. The sac is the peritoneum, or that portion of it 
which came over the aperture, through which the hernia protrudes. 
These coverings, of course, are different in the different varieties 
of hernia, and this must be well considered before operating. 

The account I have given is a mere skeleton, but is probably 



160 Surgical Diseases of the Intestines. 

sufficient to serve as an introduction to the subject of the treat- 
ment. Care must be taken not to confound an irreducible hernia 
with glandular enlargements, or tumors of other kinds. In hernia, 
whenever the patient coughs, there is " an impulse felt in the tu- 
mor," which does not occur in any other variety. Then the sud- 
denness of its appearance, its elasticity, obstructed intestinal action, 
may be considered good presumptive evidence of its being hernia. 
As homceopathists our success has been truly gratifying in the 
reduction of strangulated hernias, without other aid than that de- 
rived from our remedies. We do not, however, disparage operative 
measures, for the necessity for their employment may occur from 
the failure of remedial action, either from the poor selection of the 
remedy, or from some organic causes, as the existence of plastic 
bands. By waiting too long for the action of remedies, gangrene 
may set in, and the operation will then be rendered useless from 
too much time having been lost. No definite length of time can 
be given in which medicine should be used alone before resorting 
to operation ; each physician must let the particular case, - and his 
own judgment, determine. 

Intestinal Obstructions. 

This distressing disease, if such it may be called, is known as 
either acute or chronic. The acute form is an obstruction to the 
passage of the contents of the bowel from one of four causes : ist. 
From mechanical causes, of one of two forms. From a portion 
of the intestine becoming engaged and strangulated in an aperture 
in the mesentery ; or from direct violence. 2d. From invagination ; 
or one portion of the gut slipping into the other : the upper part 
into the lower. 3d. From a portion becoming twisted. 4th. From 
cancerous constriction. Still another cause, however, may be 
enumerated, that of constriction exercised by the formation of 
plastic bands. And, again, there may be a simple spasmodic con- 
striction, due to other causes, as cerebral, etc. The symptoms 
attending a case of the acute variety are as follows : Constipation, 
pain, and vomiting. The pain is felt at the point of stricture, and 
is followed by vomiting, first of the contents of the stomach, later 
by that of the intestines. Frequently, however, the stercoraceous 
matter is vomited from the first. Great physical depression. 
swelling of the abdomen, rumbling of flatus, and, as a matter of 



Special Therapeutics, 161 

course, no alvine discharge. Later there is much mental disor- 
der, and great physical agony. Patients have been known to live 
for two or more weeks in this condition. Death may ensue from 
exhaustion, gangrene, and, in some cases, peritonitis. I made a 
post mortem on the body of a man in Philadelphia in October, 
1867, in which the intestines were found to be enormously dis- 
tended, filled with gas and a black, watery, and fetid fluid. There 
were three strictures, all of them giving the appearance of a string 
drawn around the gut. One was at the commencement of the jeju- 
num, the other near the termination of the ileum, and the third just 
above the sigmoid flexure of the colon. This last seemed to be 
the oldest, the most recent one being that of the jejunum. 

The chronic form arises from one of three causes usually. 1st, 
Scirrhus, which gradually narrows the intestine, until suddenly it 
is completely occluded ; 2d, from the pressure of tumors; and 3d, 
from the accumulation of hardened faeces. The large intestine is 
usually the seat of this form of the disease. The symptoms prior 
to this complete closure, may be almost anything indicating some- 
thing wrong with the intestines, and are not readily described. 
After the occlusion, they are much the same as those occurring in 
the acute form, only coming on more slowly, and gradually in- 
creasing in intensity. Individuals suffering with this disease have 
been known to live for weeks, even after the complete occlusion 
had occurred. 

Treatment. 

In the treatment of hernia, great care must be taken not to let 
the strangulation culminate in gangrene. In the acute form of in- 
testinal obstructions, great and decided results have been time and 
again obtained. But the chronic form is one that oftener defies all 
relief. Here the pathological condition must be taken into the ac- 
count. If it be due to the pressure exerted by a tumor, then 
" pressure effects " will not constitute the picture of the remedy ; 
the obstruction being, as it were, mechanical, must be removed by 
mechanical measures. If scirrhus be the cause, there will proba- 
bly be symptoms enough to indicate the real trouble, and the rem- 
edy. I know of no remedies that I can confidently recommend 
for this distressing trouble ; each case must be considered alone. 
The complications that may arise are so very numerous, that the 
whole Materia Medica would but barely cover the ground. 



1 62 Surgical Diseases of the Intestines. 

The selection I have made of the remedies, includes such as I 
supposed would be the oftenest called for, and are, Aconite, Ars., 
Aur., Bell., Borax, Bry., Calc, Carbo v., Cina, Cocc., Gets., Lack., 
Lye. Magn., carb., Nit. ac, Nux v., Opi., Plumb., Rhus, Sil., Stan., 
Sulph., Thuja, Verat. 

The Index may be arranged as follows : 
Hernia : Umbilical : Aur., Borax, Calc, Cocc, Cina, Nux v., 
Nit. ac, Sil., Stan., Verat. 

Inguinal : Aur., Cocc, Magn. c, Nux v., Sil., Verat. 

Strangulated: Aeon., Nux v., Opi., Sulph., Ars., Bell., 

Gels., Lach., Lye, Verat. 

Intestinal Obstruction : Acute : Cocc, Bell., Nux v., Opi., 
Thuja, Ars., Bry., Carbo v., Rhus, Lach. 

Chronic : 

Aconite nap. Vomiting, with nausea, thirst, heat, profuse 
sweat, and enuresis ; vomiting of lumbrici ; drawing, burning, or 
pinching in the umbilicus ; sensitiveness of the abdomen to the 
touch ; inflammation of the bowels and peritoneum ; distension of 
the abdomen, with paroxysms of anguish , swelling and distension 
of the abdomen, as if from dropsy ; inflammation of the hernia 
stricture, with bitter bilious vomiting ; violent inflammation of the 
parts affected in hernia, with burning pain in the abdomen as if 
from red-hot coals. 

Worse in the morning, evening, and night ; also from anger or 
fright, from cold, when lying on the left side, on being touched, and 
when turning in bed. 

Better when lying on the back or right side, and from warmth. 
Left side. 

Arsenicum alb. Hard bloated abdomen; burning pains with 
anguish ; sensation of coldness in the upper part of the abdomen , 
general and rapid sinking of strength ; great debility ; vomiting of 
everything he eats or drinks; excessive pains in the whole abdo- 
men ; pains with great anguish , lamentations, tossing about ; in- 
ternal restlessness, which does not allow one to be still ; despair of 
getting well ; a sensation as if the intestines became twisted ; 
writhing sensation in the abdomen; gangrene of the hernial tumor. 

Worse in the evening and at night ; also from anger, from cold, 
and when lying on the back. 

Better from warmth. Right side. 



Special Therapeutics. 1 63 

AurUITI met. Pressure in the abdominal ring, as if hernia would 
protrude when sitting ; protrusion of inguinal hernia, with great 
cramp-like pains ; inguinal hernia of children ; umbilical hernia in 
children, caused by crying. 

Worse in the morning and at night ; also from cold, when lying 
down, and when standing. 

Better from pressure, and from warmth. Right side. 

Belladonna. Distended, but neither hard nor painful abdomen ; 
constriction of the abdomen around the umbilicus, as if a lump or 
a ball would form there ; colic, as if a spot in the abdomen were 
seized by the nails ; griping, clutching, or clawing in the abdomen ; 
constipation, with inflation in the abdomen, and heat in the head. 

Worse in the evening and at night ; also from anger or fright, 
from cold, and on being touched. 

Better when lying down, also when standing, and from warmth. 
Either side. 

Borax Yen. Cures infantile hernia, when there are the follow- 
ing symptoms : The child dreads a downward motion ; even when 
asleep it suddenly awakes if an attempt is made to put it in the 
cradle or bed ; also very nervous ; also the rumpling of paper, the 
rustling of a silk dress, sneezing of others, the falling of a door- 
latch, causes it to wake, and when waked to cry continually ; does 
not thrive ; is very apt to have a brown watery diarrhoea. 

Worse in the evening ; also from cold, when lying on the right 
side, and when turning in bed. 

Better when lying on the left side, from pressure, and from 
warmth. Right side ? 

Bryonia alba. Hard swelling of the hypochondria, and around 
the umbilicus ; painful twisting around the umbilicus with stitches ; 
constipation. 

Worse in the evening and at night ; also from anger, when 
changing the position, when lying on the left side, from being 
touched, and when turning in bed. 

Better from cold, when lying on the back, and when sitting. Left 
side. 

Calcarea Carb. Guernsey gives the following indications for the 
use of this remedy in infantile hernia : Very open fontanelles ; per- 
spires freely about the head when sleeping, so as to wet the pillow 
far around ; or when the child is colicky, and cries much, by spells, 
day and night; does not sleep much after 3 a.m. ; often cries much 



164 Surgical Diseases of the hiiestines. 

then. Lippe adds, considerable distension of the abdomen with 
colic ; drawing in the abdomen ; distension and hardness of the 
abdomen ; constant gurgling in the abdomen. 

Worse in the morning, evening, and at night ; also from cold. 

Better from warmth, and on loosening the garments. Right side. 

Carbo Veg. Great anxiety, with uneasiness in the abdomen, 
distension from incarcerated flatulence, in the left side of the epi- 
gastrium, attended with a crampy pain ; the flatus becomes incar- 
cerated in different parts of the abdomen, under the floating ribs, 
and in the region of the bladder, and slowly passes off with a sense 
of heat in the rectum. 

Worse in the morning and forenoon; also from changing the 
position, from pressure, on being touched, and when turning in bed. 

Better after lying down. Right side. 

Cina. Guernsey gives the following indications in infantile her- 
nia : The child does not thrive ; never sleeps quietly ; it is always 
in motion, even in its most quiet slumber, which is never long at a 
time ; when awake it always cries, and is very cross ; it sometimes 
refuses almost everything it is offered ; nothing seems to satisfy it ; 
it is constantly worrying and crying. 

Worse at night ; also from pressure, while sitting, and from 
warmth. 

Better after lying down. Left side. 

CoCCllluS ind. Lacerating in the intestines ; distension of the 
abdomen ; vomiting with bruised pain in the intestines ; great 
weakness, and inability to stand. 

Worse in the evening ; also from cold. 

Better from pressure, and from warmth. Right side ? 

Gelseminiim. Recommended by Hale, but the symptoms given 
in his book (1st ed.) are not in the least characteristic, and as far 
as he goes, it seems to be merely " supposed " to be of use. Lippe's 
symptoms are, gnawing pain in the transverse colon ; sudden spas- 
modic pains in the upper portion of the abdomen, compelling him 
to cry out, leaving a sensation of contraction ; symptoms brought 
on by fright, or the sudden hearing of bad news. It has been 
recommended by some authors in the treatment of strangulated 
hernia, but I have not been able to find a case treated by it ; it is 
more probably of greater utility in intestinal obstructions. 

LsiCheSIS. Particularly useful when gangrene threatens in stran- 
gulated hernia ; the skin covering the hernial tumor is mottled or 



Special Therapeutics, 165 

dark ; pain across the abdomen ; contractive sensation in the ab- 
domen; cutting, lacerating, or burning in the abdomen; burning 
around the umbilicus ; hard distension of the abdomen ; the her- 
nial tumor is exceedingly sensitive, will not admit of handling. 

Worse in the evening, and at night ; also when changing the po- 
sition, and from pressure. 

Better from warmth ? Right side ? 

LyCO podium. Full, distended abdomen, with cold feet; spas- 
modic contraction in the abdomen ; drawing pain in the abdomen, 
also with pressure ; grumbling and gurgling in the abdomen ; lac- 
erating stitches in the hernia. 

Worse in the afternoon, evening, and at night ; also from anger, 
when changing the position, when lying down, from pressure, on 
being touched, and from warmth. 

Better from cold, and when lying on the back. Right side. 

Magnesia carb. Spasmodic contractive pains in the abdomen ; 
retention of stool. 

Worse in the evening, and at night ; also from cold, from pres- 
sure, and on being touched. 

Better from warmth. Left side. 

Nitric acid. Drawing pain in the abdomen, with shuddering; 
frequent pinching in the abdomen ; rumbling in the abdomen ; ex- 
cessive sensitiveness of the abdomen. 

Worse (all times of day alike ; rather worse at night) ; also from 
pressure, and on being touched. 

Better on getting warm. Left side. 

NlIX V01T1. Contractive pain in the hypogastrium ; griping, and 
clutching in the epigastrium ; pinching in the abdomen ; bruised 
pain in the bowels ; pain in the bowels as if raw and sore ; fre- 
quent protrusion of inguinal hernia ; all kinds of hernia, with red 
or yellowish foci, some tenderness from pressure on the tumor, 
nausea, and vomiting. Useful in nearly every case of strangulated 
hernia. 

Worse in the morning ; also from anger or fright, when lying on 
the back or right side, and when turning in bed. 

Better while lying on the left side, and when sitting or standing. 
Right side. 

Opium. Redness of the face ; distension of the abdomen ; vom- 
iting of putrid matter ; vomiting of feculent matter ; vomiting of 
urine ; pain in the abdomen as if the intestines were cut to pieces. 



1 66 Surgical Diseases of the Intestines. 

Worse at night ; also from fright, and during and after sleep, 
Either side. 

Plumbum met. Excessive pains in the abdomen ; violent pains 
in the region of the umbilicus. 

Worse in the evening, and at night ; also from motion. 

Better from rubbing. Left side. 

Rhus tOX. Cramp-like drawing in the umbilical region ; dis- 
tension of the abdomen in the umbilical region, with violent pinch- 
ing. 

Worse in the morning, evening, and at night ; also when chang- 
ing the position, from cold, when lying on the back, from standing, 
and on being touched. 

Better from pressure, and from warmth. Right side. 

SHicea. Guernsey says (speaking of hernia), when the child is 
very tender to the touch around the tumor : the tumor is painful, 
and the child is easier when it recedes ; vomits up the milk pro- 
fusely after nursing ; dreads to be moved ; frequent colicky pains, 
which are relieved by a discharge of very offensive flatus ; €at, dis- 
tended abdomen. 

Worse at night ; also from cold, when lying on the back or left 
side, from pressure, and on being touched. 

Better from warmth. Right side. 

Stannum met. Guernsey says of this remedy, when the suffer- 
ings are relieved by pressing on the abdomen ; it must lie over the 
nurse's shoulder, or across her knee, or the hand must be pressed 
firmly on the abdomen. Sensitiveness of the abdomen to the touch. 

Worse in the evening ; also when lying on the painless side. 

Better when lying on the back, and from loosening the garments. 
Right side. 

Sulphur. Painful sensitiveness in the whole abdomen, as if the 
parts in it were raw and sore ; pain as if something would be torn 
out ; spasmodically contractive colic ; painfulness in the abdomen 
when touching it ; inflamed strangulated hernia ; painful inguinal 
hernia ; rumbling in the hypogastrium as if empty. 

Worse in the evening, and at night ; also when standing, and 
when touching the parts. 

Better by drawing up the limbs, when lying on the right side, and 
from heat. Left side. 

Thuja OCCJ. The upper part of the abdomen is drawn in; 
movement in the abdomen as if from something alive ; the muscles 



Special Therapeutics. 



167 



are pushed out as if by the arm of a foetus, but painless; flatu- 
lence as if an animal were crying in the abdomen. 

Worse in the evening, and at night ; also from cold-wet. 

Better from warm-wet. Right side. 

Veratrum alb. Cutting colic ; distension of the abdomen ; pain 
in the abdomen here and there, as if cut with knives. 

Worse in the morning ; also after sleep. 

Better from cold. Right side. 

Before closing the subject of treatment, it will be well to men- 
tion one or two methods of temporary relief in irreducible. hernia. 
Injections of molasses have frequently been spoken of as very use- 
ful ; this substance is not used for any medicinal properties it pos- 
sesses, but merely by its weight is supposed to force the intestines 
back, and is probably a good thing for " inside help." Others 
have used some tin kitchen utensil, which by the aid of fire is so 
applied, that acting as a cup, it will " suck " the lower part of the 
intestines out, and thus reduce the stricture. This is, to say the 
least, a very doubtful thing, as the portion which would be acted 
on is the small intestine, and you mig/zthave to " suck " out twenty 
feet before any inside traction would be made. The proprietor of 
this novel if not ingenious appliance, should take out a patent- 
right forthwith. The practice of raising a person by his feet, and 
shaking him, has been adopted in several cases, and with good 
results. Stand with your back to the patient, draw the legs over 
your shoulders as far as the knee, raise him completely up head 
downwards, raise yourself on the toes, and come down heavily on 
the heels. This would probably answer well in many cases. The 
inflation of the intestines with water or air, either with a syringe, 
bellows, or by generating free gas in the intestine, has relieved 
some cases of intussusception. 

Operations. 



The operations in vogue for both of these affections, are of a 
somewhat complex nature, and will consequently be but glanced 
at here. Amusat revived an old operation for the purpose of re- 
lieving the stricture in intestinal obstructions. From the danger 
of peritonitis which followed the wounding of the peritoneum when 
the operation was performed through the anterior parieties of the 



1 68 Surgical Diseases of the Intestines. 

abdomen, he performed gastrotomy by an incision from behind. 
Erichsen prefers one in the side. Either operation is good, but 
highly dangerous. 

In hernia, as well as in the preceding case, the coverings of the 
intestine must be carefully studied and fixed in the mind ; other- 
wise a man may not divide the stricture all, or else may open the 
gut by mistake for the sac. First expose the point of stricture, then 
cut it. Make the incision which will as far as possible avoid the 
larger vessels, then raise each successive layer of the coverings on 
a director, and separate them carefully. Make yourself acquaint? 
ed with the condition of the knuckle of intestine, but if possible 
avoid opening the sac. 



SURGICAL DISEASES OF THE ANUS 
AND RECTUM. 



haemorrhoids — ulcer and flssure of the anus flstula 

in Ano — Prolapsus Recti. 

haemorrhoids. 

Some authors, and from what I can learn only in our own ranks, 
speak of haemorrhoids as being an effusion of blood into the cellu- 
lar tissue in the neighborhood of the anus. This is manifestly in- 
correct. The disease is a varix of the haemorrhoidal veins, and of 
the veins in that neighborhood, chiefly the inferior mesentery, and 
are bleeding, blind, internal, and exteriial piles, or haemorrhoids. 
The internal are those which are situated entirely within the anus, 
and may either bleed or not. The external are those which are 
wholly or in part outside of the anus, and are always blind. The 
disease is very common, from the imperfect support given to the 
veins, and is usually associated with constipation. It is more com- 
mon to men than women, and is rather peculiar to young people 
or those of middle life. A sedentary life, particularly when asso- 
ciated with high living, readily induces the disease. Indeed, any- 
thing that will tend to increase the circulation, or rather the 
amount of blood in the veins, at the same time that it relaxes the 
tone of the parts, predisposes strongly to the production of piles. 
This condition is usually associated with some prolapsus of the 
rectum. 

Ulcer and Fissure of the Anus. 

Fissure of the anus, is a rhagade or crack, extending from some 
point in the rectum across the sphincter to the verge of the anus. 
Occasionally these appear without any other complication, but 
usually an ulcer is the point from which the fissure takes its start. 



1 70 Surgical Diseases of the Anus and Rectum. 

On passing the finger into the rectum, a small velvety elevation 
will be readily detected, and the truth of our supposition as to 
whether it be an ulcer or not, will be determined by the sensation 
of the patient. If it be an ulcer, a very acute and burning pain 
will be experienced on touching it. Considerable pain and gen- 
eral disturbance accompanies this condition, trivial as it may ap- 
pear. One or more ulcers may exist alone without any fissure, or 
fissures without any ulcer ; or, one ulcer may be accompanied by 
two or more fissures, and vice versa. The more prominent symp- 
toms are, a burning and somewhat acute pain, more particularly if 
the stool be a hard one. Sometimes this pain does not appear 
until sometime after the passage of the stool. The urinary appa- 
ratus is also frequently affected, there being a constant desire to 
urinate, with some symptoms of stricture. 

Contraction of the sphincter ani, is a condition that is very often 
present in connection with this disease, or it may be met with sep- 
arately. It is usually a neuralgic condition, and is met with among 
women who are of a hysterical disposition. When occurring in 
connection with ulcer and fissure, there will be found to be much 
difficulty in introducing the finger or instrument for the purposes 
of examination. I believe the disease is always spasmodic, not 
continuous, nor of long duration. 

Abscess of the anus, may as well be alluded to here as elsewhere. 
They differ but little from those in other parts of the body, save in 
the pus being of a very offensive odor, smelling strongly of the 
faeces, without there being any of the contents of the bowel in it. 
As Erichsen remarks, the proximity to the gut seems to determine 
this odor. An abscess in this situation should be opened early, or 
else much mischief may result. The intestine may be perforated, 
or the pus may be widely distributed over the nates. 

Fistula in Ano. 

Fistula in ano, is the sinus left from the contraction during the 
healing process of some kinds of ulcer and abscess in the neigh- 
borhood of the anus and rectum. Pathologists have mentioned 
four or more varieties, all included, however, in the terms complete 
and incomplete. The only varieties found among the first, ox com- 
plete classes, are in reference to their number ; anywhere from one 
to half-a-dozen, or even more. In the second class we have 1st, 



Special Therapeutics. 171 

" blind external fistula," in which there is an external opening, 
ending in a cul-de-sac, and not penetrating the intestine; 2d, 
"blind internal," in which there is an opening in the gut, but none 
in the skin. The pathology of these affections is much more in- 
teresting to the irregulars than to us ; inasmuch as the relative 
merits of operations claim all their attention, no other means hav- 
ing yet been discovered to cure them, e. g., by medicine. Often we 
will find, that even with our more perfect knowledge of medicine, 
instrumental treatment will have to be resorted to. Still this will 
be but comparatively seldom, and the day is not far distant when 
it will never be required in our hands. Electricity may be a use- 
ful agent in these affections, and at all events merits a trial. 

Prolapsus of the Rectum. 

Prolapsus Recti, is a protrusion of the mucous membrane of the 
bowel through the anus, from a relaxed condition of the muscular 
portion of the intestine. Two forms are met with ; one a simple, 
ordinary, prolapsus of the mucous membrane alone, and the other, 
a falling of the rectum as far as the muscular coat of the intestine. 
This last variety is quite a serious matter at times, as strangulation 
is then apt to arise, and produce considerable trouble. When a 
prolapsus occurs but once, and is not habitual, a simple replace- 
ment of the protruded portion is all that is necessary ; but when 
it is of frequent recurrence, measures must be taken to cure this 
tendency. These measures are not the employment of what is 
commonly called " tonics," but the administration of remedies in- 
ternally, to restore the tone of the debilitated canal. People of 
lax habit, broken-down or debilitated constitutions, as well as those 
who are habitually costive and have to strain a great deal at stool, 
are most subject to these accidents. Children are also more liable 
than adults, and women than men. It has sometimes occurred, 
that from spasmodic contraction of the sphincter in cases in which 
this occurs for the first time, gangrene has followed of the whole 
of the protruded portion. This is happily rare, as the loss of to- 
nicity also extends to the sphincter usually All artificial supports 
in these cases must be rigorously "left alone." 

Therapeutics. — The remedies most frequently employed by 
us in the treatment of these diseases axe, Aeon., Aloes, A?nber g., 



ij2 Surgical Diseases of the Amis and Rectum. 

Ant. c, Arn. y Ars., JEsculus, Bell., Bry., Calc. c, Carbo v, Cham., 

Chin., Colch., Coloc, Ferr., Graph., Ham., Hep. s., Ign., Kali., Kreos. y 

Lach., Lye., Merc., Nat. m., Nux v., Opi., Pceonia, Phos., Plat. y 

Podoph., Puis., Rhus, Ruta, Sarsap., Sep., Sil., Spig., Sulph., 

Zinc. 

The index may be arranged as follows : 

Hemorrhoids : Internal : Aeon., Aloes, Ant. c, Ars., Calc, Car- 
bo. v., Caust., Chin., Coloc, Ferr., Graph., Lach., Nat. m. y 
Nux v., Opi.. Puis., Sep., Spig., Sulph., Ham. v. 

—External : Aloes, Ambra, Am., Ars., Bell., Bry., Caust. y 

Hep. s., Lgn., Kreos., Lye, Nux v., Opi., Plat., Puis., Sulph., 
Ham. v., Zinc 

Bleeding : Aeon., Aloes, Ant. c, Ars., Calc, Carbo v., Caust. y 

Chin., Coloc, Erigeron, Ferr., Graph., Lach., Nat. m., Nit, 
ac, Nux v., Opi., Puis., Sep., Spig., Sulph., Ham. v. 

Blood: (See external.) 

Bad Effects from Suppression of : Calc c, Sulph. 

From Sedentary Life : Nux v. 

From Abuse of Liquors : Nux v. 

Inflamed : Nux v. 



Fissure of the Anus : Arn., Graph., Cal. c, Cham., Hamam. 

Hepar s., Nitro., Petrol., Rhus, Sarsap., Sulph. 
Ulcer of the Anus : Ars., Kali., Lach., Lye, Pceonia, Sarsap. 
Contraction of the Sphincter Ani : Cal. c, Colch., Lgn., Lye, 

Nux vom., Phos. 
Abscess of the Anus : Aeon., Bell., Hep. s., Rhus, Sil. 
Fistula in Ano : Berber., Calc, Calc. phos., Caust., Sil., Sulph. 
Prolapsus Ani : Lgn., Nux v., Merc, Pod., Sulph., Ars., Calc. y 

Lye, Ruta, Sep. 
Prolapsus Ani : to Prevent Tendency : Ars. Cal. c, Lyc y 

Ruta. 
in Infants : /gnat., Nux vom. 

Aconite nap. Momentary paralysis of the anus, with involun- 
tary stools ; scanty, red-hot urine, without sediment. 

Worse at night, and in the morning ; also, when bending over, 
and from cold. 

Better from warmth. 

Aloes SOCOt. Heaviness, heat, pressing, and burning in the rec- 
tum ; mucus and blood in the faeces ; itching, burning, pulsating 



Special Therapezttics. 1 73 

pain as if from fissure at the anus ; hemorrhoidal tumors pro- 
trude like bunches of grapes, and are very painful, sore, tender 
and hot ; increased secretion of urine, especially at night, con- 
stant rumbling in the abdomen, with feeling as if he must have 
stool, but no evacuation following the effort. Jelly-like, bloody 
stool. 

Worse in the afternoon ; also, when standing up or sitting still. 

Better from cold water. 

Ambra griS. Itching, smarting and stinging at the anus ; in- 
creased secretion of urine, much more than the fluid drank. 

Worse in the evening ; also when lying in a warm place, and 
on awakening. 

Better from slow motion in the open air, and when lying or 
pressing upon the painful part. 

Antimonium Crild. Continual discharge of mucus from the 
bowels ; alternate diarrhoea and constipation ; increased and fre- 
quent discharge of urine at night, with discharge of mucus, burn- 
ing in the urethra, and pain in the small of the back. 

Worse at night ; also, after bathing, and from the heat of the 
sun. 

Better during rest, or in the open air. 

Arnica mon. Painful pressure in the rectum : stools small and 
frequent, consisting only of slime ; crampy sensation in the rec- 
tum : running in the rectum when standing , tenesmus in the 
rectum. 

Worse in the morning, evening, and at night ; also, when mov- 
ing, when tfeing touched, and from cold. 

Better from pressure. 

Arsenicum alb. Burning and soreness in the rectum and anus; 
haemorrhoidal tumors with burning pain ; the rectum is pushed 
out spasmodically, with great pain, it remains protruded after 
haemorrhage from the rectum ; smaller and painful hemorrhoids ; 
varices which burn like fire, at night, stinging during the day par- 
ticularly when walking. 

Worse at night; also, from cold. 

Better from warmth. 

Belladonna. Spasmodic stricture of the rectum ; paralysis of the 
sphincter ani ; stinging pain in the rectum ; contortive pain in the 
rectum; violent itching, and constrictive sensation in the anus ; 
urine scanty, fiery red, dark, turbid. 



1 74 Surgical Diseases of the Anus and Rectum. 

Worse in the evening, and at night ; also, on moving, or when 
touching the parts. 

Better while standing, or when lying down. 

Berberis Vlllg. Fistula ani with great soreness and pain through- 
out the entire back, from sacrum upwards, greatly increased when 
the patient performs any labor. 

Bryonia alb. Hard, tough stool, with protrusion of the rec- 
tum ; long-lasting burning in the rectum after hard stool ; sharp, 
burning pain in the rectum with soft stool ; white and turbid 
urine, sensation of constriction in the urethra when urinating. 

Worse in the morning ; also, from motion, and from heat. 

Better while lying down, or in getting warm in bed. 

CaScarea Carb. Discharge of blood from the rectum ; prolap- 
sus ani, with constipation ; itching of the anus ; varices smaller, 
protruding, and burning ; violent pressure in the rectum ; burn- 
ing in the rectum ; pricking of the rectum as if from ascarides ; 
grape-like eruption around the anus, painful and burning : fre- 
quent micturition, also at night ; during micturition, burning in 
the urethra. 

Worse in the morning, evening, and at night ; also, in the cold 
air, from the pressure of the clothes, and in wet weather. 

Better from loosening the garments, and from warmth. 

CalC. phOS. Fistula ani, in persons who have pains in the joints, 
with every spell of cold, stormy weather. Fissures of the anus, in 
tall, slim, light complexioned children, and who form bone and 
teeth slowly. 

Carbo Veg. Consumption, with hard, tough and scanty stool; 
the stool, if soft, is passed with difficulty ; discharge of blood 
from the rectum : burning varices, burning at the anus, after 
stool ; soreness of, and oozing of moisture from the perineum ; 
frequent and anxious urging to pass urine ; copious emission of 
light yellow urine. 

Worse in the morning ; also, in the open air, from poultices, 
and from pressure. Better after lying down. 

Causticum. Fistula, with thin acrid discharge. Haemorrhoids 
sore and painful from walking. 

Chamomilla VUlg. Constipation from inactivity of the anus; 
inflamed varices, with ulcerated rhagades of the anus ; itching 
pain at the anus ; ineffectual urging, with anguish during micturi- 
tion ; smarting pain in the urethra during micturition. 



Special Therapeutics, i 75 

Worse at night ; also, while lying down. 

Better from warmth? 

China. off. Difficult passage of faeces, even when soft, as from 
inactivity of the bowels; stitches in the rectum, also during stool; 
tingling in the anus, as if from ascarides ; discharge of mucus 
from the rectum ; bleeding piles ; urine is dark, turbid and scanty ; 
frequent micturition. 

Worse at night ; also, from touching the parts softly. 

Better in the house. 

Colchicum aut. Stool scanty, discharged only by hard strain- 
ing, even of the soft stool, with pain in the small of the back ; 
extremely painful stool ; ineffectual pressing to stool, he feels the 
faeces in the rectum, yet cannot expel them ; during stool, sensa- 
tion as if the sphincter ani were torn to pieces ; burning at the 
anus ; spasms of the sphincter ani ; frequent micturition. 

Worse in the evening, and at night ; also, from cold, when walk- 
ing, and from being touched. 

Better while sitting, or lying down. 

Colocynthis. Constriction of the rectum during stool; dis- 
charge of blood from the rectum, with stinging, burning pain in 
the small of the back and anus. 

Worse in the afternoon, and in the evening; also during rest. 

Better from motion. 

Fermm ITIBt. Contractive spasm in the rectum; protrusion of 
large varices at the anus; painless diarrhoea; involuntary mic- 
turition, particularly in the day time. 

Worse in the morning, and at night ; also, when at rest. 

Better from slow motion. 

Graphites. Constipation, with hard, knotty stools, in lumps, 
united by a thread of mucus ; burning of the rectum, with sour- 
smelling stool ; itching and sore feeling of the anus ; varices of 
the rectum, and between them burning rhagades at the anus ; pro- 
lapsus recti with the varices, as if the rectum were paralyzed ; 
frequent micturition ; particularly at night. 

Worse at night ; also, from cold. 

Better from warmth, and in getting warm in bed. 

Hamamelis Virg. This remedy, I am sorry to say, has always 
been used by me empirically; it has, however, since I commenced 
using it, rarely failed to cure any case of haemorrhoids. I use it 
topically. Anal fissure. 



1 76 Surgical Diseases of the Anus and Rectum. 

Hepar Slllph. Constipation, with hard, dry stool ; even when 
the faeces are not hard, they are expelled with great difficulty; 
haemorrhage from the rectum, with soft stool ; soreness of the 
rectum after stool, with ichor; burning at the rectum; protrusion 
of the varices ; perspiration on the perineum ; the urine is passed 
slowly, and with difficulty. 

Worse at night ; also from cold air, from pressure, and from 
touching the parts. 

Better from warmth. 

Ignatia am. The stool is of too large size, soft, but very difficult 
to discharge ; stitches from the anus, up the rectum , itching and 
creeping in the rectum as from ascarides ; prolapsus ani, with 
smarting pain from slight pressure to stool; constriction of the 
anus after stool; frequent discharge of watery urine. 

Worse in the evening, and in the morning; also, after lying 
down. 

Better when lying on the back. 

Kali Carb. Constipation with difficult emission of too large 
sized faeces ; retarded stool, from inactivity of the rectum ; smart- 
ing pain at the anus, with diarrhoea; continual burning at the 
anus of the stool ; discharge of blood with the stool ; itching and 
tingling of the anus ; ulcerated pimples at the anus ; protrusion 
and distension of the varices during stool, with pricking and burn- 
ing; protrusion of the varices during micturition, emitting first 
blood, then white mucus; inflammation, soreness, stitches, and 
tingling, as from ascarides in the varices, frequent micturition, 
with discharge of small quantity of fiery urine ; the urine is dis- 
charged slowly. 

Worse in the morning ; also, when at rest, from cold, and when 
lying on the side. 

Better on getting warm. 

KreOSOte. Constipation, the stool being hard, dry, and only 
expelled with difficulty; stitches in the rectum extending towards 
the left groin ; diminished secretion of urine, although he drinks 
much. 

Worse in the morning; also in the open air, and in morning. 

Better from warmth. 

Lachesis. Constipation, with ineffectual desire to evacuate; 
constriction of the rectum, or sensation as of a plug in the anus-, 
stitch in the rectum when laughing or sneezing; haemorrhoidal 



special Therapeutics. 177 

tumors protrude after the stool, with constriction of the sphincter; 
foaming urine ; sensation as if a ball were rolling in the bladder. 

Worse in the evening ; also, in the open air, and from cold. 

Better from warmth, or in the house or room. 

LyCOpodium. Constipation, hard stool with ineffectual desire 
to evacuate; desire for stool, followed by painful constriction of 
the rectum or anus ; haemorrhage from the rectum, even after a 
soft stool; feeling of fullness in the rectum, which continues after 
a copious stool; contractive pain in the perineum, after scanty 
hard stool ; stitches in the rectum ; itching and tension in the 
anus ; itching eruption of the anus, painful to the touch ; painful 
closing of the anus ; protrusion of the varices ; distension of the 
varices of the rectum ; frequent desire to urinate, copious emis- 
sion ; sandy sediment in the urine. 

Worse in the afternoon ; also, when lying down, or sitting, and 
from the pressure of the clothes. 

Better from cold. 

MerCUNUS. Constipation, stool tenacious or crumbling, can 
only be discharged after violent straining ; discharge of blood be- 
fore, during and after stool ; burning pain in the anus with a loose 
stool ; discharge of mucus from the rectum ; after the stool pro- 
lapsus ani, or when straining and pressing to stool ; the rectum is 
black, discharging blood ; frequent and violent desire to urinate, 
with scanty discharge and feeble stream. 

Worse in the evening, and at night ; also, from the heat of the 
bed, and when exercising. 

Better when at rest, or while lying down. 

Natrum mur. Constipation, stools difficult to discharge, hard, 
dry, crumbling, like sheep's dung; difficult stools, with stitches in 
the rectum ; passes blood with the stool ; during and after stool 
burning in the anus and rectum ; piles with stinging pain ; soreness 
at the anus, and around it, when walking; tetter at the anus; fre- 
quent and strong desire to urinate, with profuse discharge. 

Worse in the forenoon ; also, from any exertion. 

Better when lying on the back or right side, and after lying 
down. 

Nitric acid. Anal fissure, or hemorrhoids with painful burn- 
ing in the rectum, after stool; and after micturition, excessive 
irritation ; anxiety and general uneasiness after stool. Bleeding of 
23 



1 78 Surgical Diseases of the Anus and Rectum, 

varices of anus during stool ; swelling and almost continuous pro- 
trusion of the varice ; almost daily contraction of anus. 

NUX VOm. Constipation ; stools insufficient, black, hard, often 
streaked with blood, as from inactivity of the intestines ; stools 
like pitch ; painful blind piles ; painful, ineffectual urging to uri- 
nate. 

Worse in the morning ; also, from motion, and on being lightly 
touched. 

Better from strong pressure. 

Opium. Constipation, from inactivity of the intestines; the 
stools are retained spasmodically ; suppression of urine, as from 
contraction, or paralysis of the bladder. 

Worse in the night ; also, after sleep, and on becoming heated. 

Better from motion. 

PaBOnia. Painful ulcer at the anus, with exudation of a foetid 
moisture, extending towards the perineum. 

Phosphorus. Constipation, small-shaped hard stool, and ex- 
pelled with great difficulty ; discharge of blood from the rectum, 
also during stool ; spasms in the rectum ; paralysis of the lower 
intestines, and the sphincter ani ; discharge of mucus out of the 
wide-open anus; stinging or itching at the anus ; easily-bleeding 
piles ; increased secretion of watery, pale urine ; involuntary dis- 
charge of urine. 

Worse in the evening, and at night ; also, when lying on the 
back, or left side. 

Better when lying on the right side, from rubbing, and after 
sleeping. 

Platina. Itching, tingling, and tenesmus at the anus, in the 
evening ; frequent micturition, with slow flow of urine. 

Worse in the evening ; also, when at rest. 

Better during motion. 

Podophyllum. Constipation with flatulence and headache; 
feces hard and dry, and voided with difficulty ; prolapsus ani, with 
diarrhoea ; descent of the rectum from a little exertion, followed 
by stool, or by thick and transparent mucus, sometimes mixed 
with blood ; suppression of urine ; or involuntary urination during 
sleep. 

Pulsatilla. Difficult soft stool, with straining and back-ache ; 
during stool congestion of blood to the anus; piles with great 
soreness ; incontinence of urine ; scanty, red-brown urine. 



Special Therapeutics. 179 

Worse in the evening ; also, from heat. 

Better from cold. 

Rhus tox. Sore haemorrhoids, protruding after stool; frequent 
urging to urinate day and night, with increased secretions ; in- 
voluntary discharge of urine at night, or while sitting. 

Worse at night ; also, from cold and pressure. 

Better from warmth. 

Ruta graveolens. Prolapsus ani with every stool, either soft or 
hard ; frequent unsuccessful urging to stool, with prolapsus ani ; 
soft stool, which from inactivity of the bowels, is discharged with 
difficulty ; frequent desire to micturate, with scanty emissions. 

Worse in the afternoon ; also, during wet, and from cold. 

Better from motion. 

Sarsaparilla. Difficult and painful stool, with fainting attacks ; 
stool retarded, hard, and insufficient; frequent inefficient urging 
to urinate, with diminished secretion. 

Worse in the afternoon ; also, from cold. 

Better from warmth. 

Sepia. Insufficient stool, with straining and tenesmus ; dis- 
charge of blood with the stool ; pain in the rectum as from con- 
traction ; itching, burning, and stinging in the rectum and anus ; 
sensation of a leaden ball in the rectum oozing from the rectum; 
discharge of mucus from the rectum, with stinging and tearing; 
frequent micturition. 

Worse in the forenoon, and in the evening ; also, when at rest. 

Better from warmth, and when violently exercising. 

Silicea. Constipation ; difficult hard stool, which is large, and 
if partly expelled slips back again, as if there was not power enough 
to expel it ; even the soft stool is expelled with much difficulty ; 
itching in the anus and rectum, also during stool; continuous 
urging to urinate, with scanty discharge. 
Worse in the night; also, from cold. 

Better from warmth. 

Spigelia. Frequent, though inefficient, urging to stool ; dis- 
charge of large lumps of mucus without faeces ; itching and tick- 
ling at the anus, and in the rectum ; frequent micturition, with 
profuse discharge. 

Worse in the forenoon, and at night ; also, on bending down, 
from movement, or on touching the parts. 

Better after lying down. 



180 Surgical Diseases of the Anus and Rectum. 

Sulphur. Constipation; frequent unsuccessful desire for stool ; 
stool hard, knotty-, insufficient ; during the stool, discharge of 
blood, pain in the small of the back, palpitation of the heart, con- 
gestion to the head, prolapsus recti (especially during a hard stool); 
itching, burning, and stinging at the anus, and in the rectum ; after 
stool, tenesmus, constriction of the anus, swelling of, with soreness 
and stitching in the anus, frequent micturition, with small emission. 
Worse in the evening, and at night ; also, on getting warm in 
bed, from bodily exertion, while at rest, and from touching the parts. 

Better from motion, and from heat; 

Zincum met. Constipation ; stool hard and dry, inefficient, 
only expelled by hard pressing ; sensation of soreness, and violent 
itching at the anus; tingling at the anus, as if from ascarides; 
violent desire to urinate ; retention of urine when beginning to 
urinate. 

Worse in the afternoon, and in the evening ; also, when in a warm 
room. 

Better in the open air. 

Operations. 

Should contraction of the sphincter ani be permanent — and it 
may become so — the division of a few of the fibres will sometimes 
be necessary. 

Hemorrhoids are, by irregulars, often tied ; but the practice is 
not only useless, but may be a source of positive danger. 

In fistula in ano, we will probably oftener be called to operate 
than in any other of these diseases. A probe is to be used to point 
out the direction of the canal, and then with a curved bistoury the 
whole of the tissues lying between the two openings is to be laid 
open, and allowed to heal by granulation. An instrument may be 
made that consists of a long flexible probe, terminating in abroad, 
razor-shaped blade, which will enable you to make the explora- 
tion and the incision at the same time. The cut must be made 
rapidly, as it is quite a painful operation. Fill the wound with 
lint, and let it heal from the bottom. Dissecting out the lining of 
the fistula is an operation spoken of by a French surgeon, I think 
Malgaigne but I do not think it a good, or, in many cases, a pos- 
sible operation. 



SURGICAL DISEASES OF THE PENIS. 



Syphilis — Phimosis — Paraphimosis — Balanitis — Herpes 01 
the Glans and Prepuce — Warts on the Glans. 

Syphilis. 

This is one of the diseases following impure coition. It hi ; 
been customary to begin essays on this subject with an historic .1 
account. Want of space forbids it here, and, even if it were n )t 
so, I confess to knowing nothing about it, and much doubt if ar y- 
body does. 

Writers divide the subject into three or four distinct variei .es, 
the primary, secondary, tertiary, and congenital or infantile. The 
division is strictly allopathic and antiquated, recognizing a local 
affection, then a constitutional. The poison is absorbed befoie the 
chancre or primary sore is developed ; this sore being a syn ptom 
of constitutional infection. 

As a matter of fact, then, we have primary, secondary, 2nd in- 
fantile syphilis, using the term secondary under protest for want 
of a-better word. 

Primary Syphilis. — This form consists in the development of an 
ulcer or sore, usually on the glans (in women, on the labij,, or va- 
gina), called a chancre. This is occasionally accompanied by an 
enlargement of the inguinal glands, on one or both sides, which 
may or may not terminate* in suppuration, and, to distinguish it 
from a non-specific swelling, is called a bubo. It has been de- 
monstrated to my satisfaction, of late years, that when a bubo dis- 
appears without suppurating, secondary disease is imminent ; 
when the opposite, it need not be feared. In either event, how- 
ever, syphilis is a disease we may well dread ; even JRicord, who 
may be supposed to know more about it than any m;.n of his day, 
said in the Paris Academy of Medicine, that hewouid not have a 



1 82 Surgical Diseases of the Penis. 

chancre the size of a pin's head on his person, for all the wealth 
of the world. Writers retain the two main divisions of the sub- 
ject, viz., hard and soft, but add to them a number of others, each 
at his own discretion. We read of the urethral, the phagedenic, 
etc., whilst in reality there are but two kinds of chancre, the soft or 
simple, and the hard or Hunterian. The others are but modifica- 
tions of these, either in appearance or situation. The first of these 
varieties usually heals without any of what are called " constitu- 
tional " complications; while the second, in the vast majority of 
cases, either through malpractice or from a natural course of the 
disease, runs into the secondary form. 

Simple chancre is the most common of the two. In common with 
the other variety, it commences by the formation of a small itch- 
ing pimple, which breaks, and thus forms an ulcer. The time 
which elapses between the exposure and the manifestation of dis- 
ease, is not uniformly the same in all cases : rarely is it noticed 
under three days, nor later again than fourteen. Cases are on 
record, however, in which from five to six weeks have elapsed be- 
tween the inoculation and the first development. This form of 
chancre can be called a superficial one with propriety, as it exhibits 
no tendency to dip down into the tissues deeply, but merely spreads 
along the surface. The depth is uniform, base smooth, and the 
edges are slightly elevated ; when pressed between the fingers it 
seems soft. The edges at first, and during the height of the dis- 
ease, are sharp, crested, and white; but when they take on the 
healing process, they become red and rounded. The base of these 
sores is commonly covered by a lardy-looking substance. They 
discharge quite freely, a thin yellow or ichorous pus. 

Hard chancre, or the Hunterian variety, is the opposite of all 
this. The chief distinctive characteristic is, however, the proba- 
bility, nay, the almost certainty that secondary symptoms will ap- 
pear. It is almost, if not quite, impossible to tell a hard from a 
soft chancre for the first day or two, as »it commences with a pim- 
ple, breaks, and subsequently forms a true soft ulcer; but at the 
expiration of twenty-four, or forty-eight hours, it assumes the true 
Hunterian feel and appearance. Even when the hardness is fully 
disclosed, care must be taken in forming a diagnosis, or in giving 
an opinion, as it frequently happens that the soft chancre becomes 
indurated, but does not take on all the symptoms and appearances 
of the hard form. The hard chancre, on being pressed between 



Syphilis. 183 

the finger and thumb, feels like gristle ; the hardness extends for a 
considerable distance around the sore, and not only continues 
through the whole course of the disease, but remains for sometime 
after the ulcer has healed. The edges are not raised ; they are 
sharp-cut, and descend in a sloping direction deep into the sub- 
stance of the part. Unlike the soft chancre, the surface is not 
moist and discharging pus, but dry, and frequently covered by a 
scab. As said before, this form is liable to be followed by sec- 
ondary disease. The inguinal glands are swollen, and inflamed, 
but do not as a rule suppurate. These ulcers are less likely to be 
phagedenic than the former. 

The phagedenic condition is fortunately not very often to be met 
with ; it is a terrible complication, and needs the most active treat- 
ment, and the promptest measures. The causes commonly oper- 
ating to produce a phagedenic ulceration are, a strumous diathe- 
sis, low-living, dissipation, and crowding a number of syphilitic 
cases together in one room. 

Yeldham says, dread of exposure or other strong mental condi- 
tions, and the result of allopathic medication, frequently are at 
fault. The appearance of an ulcer taking on this fearful form, has 
been spoken of in the chapter on Ulcers, but a brief reference to 
the principal symptoms may not be amiss here : Irregular-shaped 
ulcer, with jagged irritable edges ; angry appearance ; painfulness; 
a thin, ichorous discharge, and a marked disposition to extend 
very rapidly in all directions. Some cases are on record, where 
from three to six days, or even less, were sufficient for the almost 
total loss of the organs. It may be as well to state here as else- 
where, that the course of the disease in this form must be checked 
at once, and if we are unable through incompetency to find a rem- 
edy that will do it, we must employ local treatment of an ener- 
getic character. (See treatment.) 

Bubo is a swelling, inflammation, induration, and frequently sup- 
puration of the inguinal glands, usually the result of syphilis, but 
not uncommonly seen as existing like any other glandular enlarge- 
ment. It is sometimes, on the other hand, distinctly venereal, and 
yet no chancre has ever been formed. Thus Erichsen records a 
case of a young man with an enlargement of the inguinal glands 
who had not had a chancre, yet the swelling was proved to be ve- 
nereal, by the production of a true venereal sore following the in- 
oculation of one of his thighs with a small quantity of the matter 



184 Surgical Diseases of the Penis. 

obtained from the abscess. In relation to the swelling indicating 
or not the existence, or rather the commencement, of secondary- 
disease, much has been written, which after all is reduced to this 
generally received fact : When a bubo follows, or is connected 
with a soft chancre, and suppurates, secondary symptoms are sel- 
dom, if ever, developed. But, if they accompany a hard chancre, 
and do not suppurate, secondary syphilis will probably ensue. 

Secondary Syphilis. — As already intimated, this form appears 
after the supposed cure of the chancre, affecting other parts of the 
body. Writers usually confine the term to specific disease of the 
soft parts ; when it reaches the bone it is termed tertiary. I prefer 
to consider tertiary syphilis as infantile. Any part of the body 
may become the seat of disease ; the order of frequency being about 
as follows : skin, mucous membranes of nose, mouth, and eyes, 
bones and internal organs. It has long been an open question, 
whether this form of syphilis is transmissible or not. I have been 
convinced that it is. A man suffering with syphilitic pharyngitis 
and ulceration, communicated the same to his wife. A man with 
syphilitic ulcer on the lip, communicated a similar sore to his be- 
trothed. A man with syphilitic exanthemata, transmitted it to his 
wife in an aggravated form. Other instances occur in my case- 
book. Whether it insures exemption from fresh inoculation or 
not I cannot say, but think it reasonable. 

The development on the skin may be in one of the following 
forms : 

1. Exanthema. These eruptions are commonly found on the 
face, forehead, arms, chest, or abdomen ; they are one of the ear- 
liest skin complications. The eruption is first red, and latterly 
copper-colored ; they are flat and even in form, hardly amounting 
to but a simple discoloration of the skin. 

2. Pimples are also a common eruption, and present some marked 
points of difference to the ordinary papulae. In a few days after 
formation, the top or apex becomes scurfy. They may be of al- 
most any color, and are found in nearly any situation ; when situ- 
ated on the lower extremities, they are frequently more of a cop- 
per-color, but in other situations they are commonly either a pale- 
red, or dark-bluish-red. Ordinarily these pimples are not accom- 
panied by itching, which is generally supposed to be a certain sign 
of their syphilitic origin ; but it is not well to place too much re- 
liance upon it, as they sometimes itch violently. 



Syphilis. 185 

3. Psoriasis is a common complication and assumes a different 
arrangement from the ordinary variety ; it is disposed in a circular 
or ring-like manner, and is covered with small scales. When this 
is present on the palms of the hands, it is very difficult to treat. 

These three forms are those most commonly met with on the 
skin. When it has become more general, the mucous membranes, 
of the throat principally, will be found inflamed, and not unfre- 
quently the seat of obstinate sores. I have seen them, in many 
cases, exhibit all the characteristics of the primary sore, and also 
take the different varieties of these sores. One case I had some 
months ago, that suffered with ulcers of the phagedenic character 
all over the inside of the mouth. Kalibich. arrested the progress, 
but made no more impression on the case. He passed out of my 
hands, and I have never seen him since. There are such a multi- 
tude of ailments that take their rise from this prevalent disease, that 
it would require more room than we have at our disposal to men- 
tion them all as they deserve. Suffice it to say that the bones can 
become affected in almost any form, caries, necrosis, etc. Perios- 
titis, rheumatism, falling off of the hair, inflammation of the lining 
membrane of the nose, of the conjunctiva, and a long train of dis- 
eases including nearly the whole list, may be met with. 

Of what is called the syphilitic cachexia, Yeldham speaks as fol- 
lows : But before quoting him, let me say, that it is in my opinion 
either an aggravated or neglected condition of a secondary dis- 
ease, or is of the infantile or congenital variety. He says : " This 
is the most direful of all the consequences of syphilis. Here the 
very fountains of life seem to be poisoned. Every function is de- 
ranged ; the nervous and physical powers become exhausted ; the 
countenance becomes sallow ; the surface anaemic ; the flesh flab- 
by ; the body wastes ; the limbs become weak and trembling ; the 
appetite fails ; and continued nervous fever, night-sweats, and hec- 
tic supervene. Conjoined with these symptoms, are commonly 
found disease of the bones ; tubercles, ulcers, and inveterate skin 
eruptions, and death may result from general anaemia, or from 
some internal organ, previously predisposed to disease, becoming 
disorganized, such as ulceration of the lungs and intestines." To 
me this all sounds like what I would call a bad case of secondary 
syphilis. 

Infantile. — There yet remains to be touched upon, but one 
other form of venereal disease, viz., Infantile, or Congenital. 

24 



1 86 Surgical Diseases of the Penis.' 

Syphilis exhibited in the case of an infant, who may during or 
at the time of birth be inoculated from a venereal sore from the 
mother, is not a true case of infantile syphilis. Such an occur- 
rence is very rare. What we mean by the term is, an hereditary, 
constitutional taint, due to one or both of the parents having been 
suffering with the disease at the time of conception. 

Erichsen says : " The symptoms consist principally of cachexy, 
with disease of the mucous and cutaneous surfaces." " Syphilitic 
children being always described as being small, wan and wasted 
when born ; the face especially has an aged look, the features be- 
ing pinched, and the flesh soft and flabby ; the complexion gen- 
erally has a yellowish or earthy tinge, and these characters con- 
tinue until the disease is eradicated from the system of the child." 
Here let me say, that not a year ago, I delivered a woman of a 
child that at birth weighed ten pounds, and looked in all respects 
like a perfectly healthy and fine infant. In the course of a month 
or two, the symptoms of congenital syphilis manifested themselves, 
and took on the character described by Erichsen below. 

He goes on to say : " The first local sign that declares itself, is 
usually a congested condition of the mucous membrane of the nose, 
giving rise to the secretion of an offensive mucus, and causing the 
child to make a peculiar snuffling noise in breathing, as if it had a 
chronic catarrh : this snuffling may exist from the time of birth, 
but generally comes on very shortly afterwards. The disease mani- 
fests itself upon the cutaneous and mucous surfaces, sometimes 
before or at birth, in other cases not until several weeks have 
elapsed. The most common period for the recurrence of these 
signs is about the third or fourth week. The cutaneous eruption 
usually makes its appearance on the nates, the scrotum, the 
soles of the feet, and around the mouth : hence on examining a 
syphilitic child, these parts should be looked at first. It presents 
itself in three different forms ; most frequently as flat tubercles, 
varying in size from a split pea to a fourpenny piece, smooth, 
slightly elevated, and of a coppery reddish-brown color. These 
tubercles are often accompanied by cracks and fissures about the 
mouth and anus. Though commonly called squamous, they are 
not in reality scaly, but are always smooth and flat. Intermixed 
with these, are brownish maculae or spots, differing in size, and 
variously figured. The vesicular or bullous eruption is not so 
common as those first described." "It appears in the form of 



Ph im osis — Parap h miosis. 187 

vesicles, about the size of a split pea, with a dusky coppery areo- 
lar and base ; drying into brown scales or scabs, and commonly 
conjoined with the tubercular affection. These bullae are most 
frequently on the soles of the feet." 

Phimosis. 

Phimosis is a disease, or a malformation depending upon an 
unnatural elongation of the prepuce, which may, or may not, be 
associated with a constriction of the preputial orifice. I consider 
this disease to be dependent upon non-specific inflammation, or 
venereal inflammation, or the contraction exercised by a cicat- 
rized chancre, or finally, congenital. When it is congenital, 
the glans, and the whole organ in fact, is apt to be atrophied, 
from the constant pressure of the prepuce. When the disease is 
dependent upon one of the other causes, the accumulation of seba- 
cious matter or smegma may cause trouble of a rather serious na- 
ture. In all cases the first and only indication is to reduce this 
constriction, and restore the natural elasticity of the part. When 
the malformation is congenital, treatment by our remedies or any 
other is hopeless. Nothing but operative procedures need be tried. 
When inflammation is the cause, treatment that will reduce the 
inflammation will reduce the deformity. Contraction from a heal- 
ing ulcer, calls for circumcision as in the congenital case. This 
will be spoken of at the end of the chapter as usual. 

Paraphimosis. 

Paraphimosis is a condition the opposite of Phimosis in nearly 
every respect ; like it, it may be produced by inflammations either 
specific or non-specific ; it may be acute or recent, and congeni- 
tal. The prepuce in this affection is drawn back, and the prepu- 
tial orifice from some reason has become contracted to an extent 
precluding the possibility of drawing it back again. From the 
constriction thus exercised in recent cases, there is more or less 
swelling and inflammation of the glans, which may terminate in 
gangrene. Our efforts must first be made to subdue the inflamma- 
tion, and then an effort is to be made to replace the prepuce with- 
out resort to instruments. When an accident like this occurs, the 
sufferer will use all manner of means to replace the prepuce him- 



188 Surgical Diseases of the Penis. 

self, and as his efforts are apt to be very ill-advised and rough, 
when he finally applies to you, the parts will be found in an in- 
flamed condition that will much embarrass you. The application 
of cold, and the internal use of Aeon, or Am., and perhaps Bell., 
will be the treatment first called for. For the indications see 
further on. No attempt at reduction should be made until the 
inflammation is subdued. 

Balanitis. 

Balanitis is an inflammation of the prepuce, which, when neg- 
lected, runs into a diffuse suppuration. The term, however, prop- 
erly applies to an inflammation of the prepuce alone ; when the 
glans, or the mucous membrane of the glans is similarly affected, 
the term "posthitis " is used. This of course is the most severe of 
the two conditions, and is more apt to lead to the formation of 
pus. The pus thus secreted is of bad odor, and of a muco-puru- 
lent character. Some writers speak of balanitis and posthitis only 
as suppurative diseases. I am inclined to think that the terms 
should be applied to erysipelatous inflammations. The causes are 
many. Direct injuries of a mechanical nature, the friction of the 
clothing, the presence of gonorrhoeal or syphilitic disease, and a 
multitude of others ; anything, in fact, which might induce in- 
flammation. 

Herpes of the Penis. 

Herpes is a skin disease of the vesicular order, which in most 
cases runs through a regular course of increase, maturation, and 
decline, terminating in from ten to fourteen days ; it is liable to re- 
appear, however, and hence requires careful management. Herpes 
preputialisis, however, an exceedingly obstinate and annoying com- 
plaint, and does not seem to run its course in the same length of 
time that the other forms do. The following are the most promi- 
nent symptoms : A smarting and itching eruption of small vesi- 
cles, or of excoriated vesicles, on the mucous membrane of this 
locality, arising in distinct but irregular clusters, which commonly 
appear in quick succession, and are near together on an inflamed 
base. They are generally attended with heat, and considerable 
constitutional disorder. As in all surgical diseases, so in this more 
particularly, never in the treatment use any external applications. 



Warts on the Glands. 189 

Warts on the Glands. 

I have come to the conclusion, and do not doubt but that our 
writers all have, that these excrescences owe their origin to 
allopathic mercurial treatment. A homceopathist (?)told me once 
that he had seen the same results in his practice, and therefore did 
not believe it to be due to mercurial drugging. The treatment he 
pursued in all syphilitic cases, so he told me, was Merc, vi . or 
sol. j the first decimal, one grain three or four times a day ! They 
are rarely if ever seen as a result of secondary syphilis, and may 
occur as simple warts, with no venereal taint of any kind. They 
are not contagious, though there are varieties that are so. They 
are chiefly found in the angle formed by the prepuce and the 
glans, and are usually large, vascular, and of a bright-red color. 
In the female they are found in large cauliflower-looking excres- 
cences, in the vagina. They sometimes grow so rapidly, and ex- 
ercise such an amount of pressure on the prepuce, that ulceration 
of this part occurs, followed by sloughing, and the appearance of 
the growth through the skin. Sometimes this increase in size is 
inconceivably large. One case came under my notice while sur- 
geon to the Philadelphia College Dispensatory, that in the space 
of a week, from a small excrescence not larger than a grain of or- 
dinary bird-shot, pierced the prepuce and was as large as the 
point of my little finger. This was due undoubtedly to the action 
of the remedy, Thuja. The allopathic method of burning these 
excresences with Nitrate of silver, or snipping them off with scis- 
sors, should never be practiced. They may exist in great num- 
bers on the same glans, or come singly. 

Treatment. 

It is the fashion among many who would fain be called homoe- 
opathists, to treat chancre with the application of caustics, and to 
use the preparation of Mercury in a shape almost, if not quite, as 
crude as allopaths. These practices can not be too strongly con- 
demned. There is no earthly reason why our remedies need be 
any more crude in the treatment of these diseases than any other. 
Use them at long intervals, and, as in all diseases, do not repeat a 
dose until the preceding one has exhausted its action. Of course 



190 Surgical Diseases of the Penis. 

as much rest as can be obtained, with a total abstinence from 
coffee and stimulating food, is desirable. 

In phimosis, we must address our remedies to removing the 
cause. If inflammatory and temporary, subdue the inflammation, 
etc. As said before, when the disease is congenital, my opinion 
is that it is incurable as far as treatment with remedies is con- 
cerned. Some say Sulph., or Calc, will cure it even then. It 
may. Try it. The same remarks apply equally well to Paraphi- 
mosis. 

Balanitis will require strict attention to cleanliness, and in this, 
as in the others, avoid topical treatment. The same may be said of 
Herpes preputialis, and of warts. 

The remedies in common use may be arranged as follows. The 
list given does not embrace nearly all that may be needed, but they 
are those most commonly called for : 

Syphilis in general: Acid nit., Arg. nit., Ars., Am., Carbo v., 
Hepar s., Kali bic, Lack., Lye, Merc, jod., Merc, sol., K Merc. 
viv., Phos. ac, Sepia, Sil., Sulph., Thuja. 

Primary: Acid nit., Ars., Merc, jod., Merc, Sulph. 

Secondary : Arg. nit., Aur., Carbo v., Hep., Kali bic, Lach. y 

Lye, Phos. ac, Sep., Sil., Sulph., Thuja. 

Infantile : Same as for Secondary, with the addition oi 



nearly every remedy in the Materia Medica. 
Phimosis: Aeon., Am., Bell., Bry., Calc, Cann., Canth., Capsic, 

Cinnab., Hep. s., Merc, Rhus., Sep., Sulph., Thuja. 
Paraphimosis: Aeon., Am., Ars., Bell., Lach. 
Balanitis: Acid nit., Am., Aur., Con., Hep. s., Staph., Aeon., 

Bell., Calc, Kreos., Lach., Puis., Rhus., Sep., Sulph. 
Herpes: Aur., Dulc, Hep. s., Nit. ac, Petrol., Phos. ac, Sep., 

Sulph. 
Warts: Merc, Nit. ac, Thuja. 

The remedies we will consider, will be only glanced at, albeit 
the array of symptoms is large. But as the secondary and infan- 
tile syphilitic diseases present such a multitude of different symp- 
toms, affecting nearly every part of the body, it was found impos- 
sible to do more than glance at them, as it would involve copying 
the whole pathogenesis of each drug. The remedies we shall 
consider then are as follows : Aconite, Arg. nit., Am., Ars., Aur., 
Bell., Bry., Calc, Cann., Canth., Capsic, Cinnab., Con., Dulc, Hep., 



Special Therapeutics. 191 

Kreas.,Lach., Lye, Merc, Merc, cor., Merc, iod., Nit. ac, Petrol., 
Phos. ac, Puis., Rhus.. Sep., SiL, Staph., Sulph., Thuja. 

Aconite. This remedy is used considerably to allay the inflam- 
mation consequent upon accidental paraphimosis, and recent cases 
of phimosis. In balanitis it is often called for when there is itch- 
ing in the prepuce, and tingling of the genital organs. 

Arcjenflim nit. Emaciation; prickling, itching in the skin at 
night ; small itching pimples ; small pimples itching when 
scratched ; wart-shaped excresences on the skin ; vertigo in the 
morning, with headache ; tumor-shaped, itching elevations on the 
hairy scalp, and in the nape of the neck ; itching and smarting of 
the canthi; ulcers in the nose, becoming covered with yellow crust; 
discharge from the nose, resembling white pus, with clots of blood: 
emission of a few drops of urine after urinating, with a sensation 
as if the interior of the urethra was swollen ; chancres on the pre- 
puce ; want of sexual desire ; the genital organs become atrophied 
and snivelled. 

Worse night and morning; also, on waking, and in the warm 
room. 

Better in the open air. Left side. 

Arnica mont. This remedy is valuable in cases similar to those 
calling for Aeon., when there has been much handling of the 
parts, and they are dark, red, and hot. Painless or painful erup- 
tions ; itching eruptions of spots or blotches on the genital organs ; 
and the skin. 

Worse in the morning, evening, and night, and periodically; also 
on blowing the nose, on coughing, from bodily exertion, on mov- 
ing the part affected, when not swallowing, from talking, on being 
touched, when walking, and after making water. 

Better on lying down, from rubbing or scratching, and on get- 
ting warm. Right side. 

Arsenic, alb. Excessive debility; emaciation and marasmus; 
atrophy of children ; burning in the interior of the affected part ; 
spots (blue generally, in different parts of the body ; pustules ; red 
pustules, changing to burning, spreading, ichorus, and crusty 
ulcers ; spreading ulcers, and suppurating crusts on the hairy 
scalp ; chronic inflammation of the eyes ; nightly agglutination ; 
photophobia ; ulcerations in the nostrils, high up, with discharge 
of fetid and bitter-tasting ichor ; sunken countenance ; pale, 
deathy-colored face ; bloated, puffed, red face ; bluish lips, with 



192 Surgical Diseases of the Penis. 

black dots ; a brown streak is seen running through the Vermil- 
lion border of the lips ; frequent urging to urinate ; involuntary 
micturition ; burning during micturition ; inflammation and 
swelling of the genitals ; phagadcenic and gangrenous chancres ; 
swelling of the arms, with black blisters having a putrid smell ; 
spreading burning blisters on the tips of the fingers and toes ; 
copper-colored eruptions on the genitals ; burning pimples, or 
pustular eruptions on the skin. 

Worse in the evening, and at night, and periodically ; also, from 
cold, bodily exertion, when lying down, and during perspiration. 

Better when moving the affected part, from warmth, and on get- 
ting warm in bed. Either side. 

Auriim. An excellent remedy for those suffering from secon- 
dary disease, who have been under a course of Mercury. Low- 
spirited, desire to die; the bones of the skull are painful when 
ljmg on them ; exostosis on the head ; caries of the mastoid pro- 
cess of the temporal bone, with foetid otorrhoea ; caries, of the, 
nose, with offensive discharge of pus from the nose ; inflammation 
of the bones of the face ; putrid smell from the mouth, with caries 
of the palate ; ulcers which attack the bones. 

Worse in the morning ; also, on getting cold, and when lying 
down. 

Better, from moving, when walking, and when getting warm. 
Left side principally. 

Belladonna. Bubos that are large and painful, accompanied 
by intense inflammation, the integuments presenting a deep red 
hue, and extending over considerable surface, the redness disap- 
pearing on pressure, and returning again as soon as the finger is 
removed ; also useful in phlegmonosus inflammation in phimosis, 
and paraphimosis. In balanitis it is particularly, and, in fact, in 
all those cases taking on an erysipelatous. Painful eruptions ; 
eruption like blotches on the genitals ; on the skin an eruption of 
pimples ; also painful eruption of pustules. 

Worse, in the afternoon, evening, and at night ; also, when 
blowing the nose, from cold, on coughing, on getting heated, on 
moving, especially the part affected, from wet poultices, making 
water. 

Better, while lying down. Right side. 

Bryonia alba. Itching, red, milliary eruption on the glands , 
also, a biting, burning or itching eruption of pimples on the skin. 



Special T her ap etches. 193 

Ca I Care a Carb. I have found this remedy principally useful in 
the case of children ; it is also good in cases of balanitis, with a 
thin watery discharge in persons of a strumous habit, who are 
afflicted with glandular enlargements. Burning of the gland or 
labia ; also of the genitals generally ; burning eruptions on the 
genitals ; dry and copper-colored eruptions on the genital organs ; 
biting or corroding eruptions of a chappy appearance on the 
skin. 

Worse morning, evening and night ; also, when blowing the 
nose, after coition, when coughing, from wet poultices, from talk- 
ing, and after urinating. 

Better after eating, when lying down, and from rubbing or 
scratching. Right side. 

Cannabis Sat. Swelling, and copper redness of the nose ; pale 
face ; eruption in the vermillion border of the lips ; inflammatory 
swelling of the prepuce, with dark redness ; the penis feels sore 
and burnt when walking ; rheumatic tearing, as if it were in the 
periosteum, after walking. 

Worse from bodily exertion, after a meal, from talking. Right 
side. 

CantharideS. Used more particularly in cases of gonorrhceal 
phimosis. Burning of the labia; itching eruption on the skin; 
eruption of pimples. 

Worse in the afternoon and night, and periodically ; also, from 
blowing the nose, from wet poultices, and during and after mictu- 
rition. 

Better when lyiDg down, during and after perspiration, from 
rubbing or scratching. Right side. 

Capsicum an. Swelling behind the ears painful to the touch ; 
burning blisters in the mouth ; fetid odor from the mouth ; in- 
flammation, with dark redness and burning of the throat ; dis- 
charge of blood from the urethra, which is painful to the touch ; 
purulent discharge from the urethra ; dwindling of the testes. 

Worse on beginning to move. 

Better from continued exercise. Left side. 

Car bo veg. Syphilitic ulcers with high edges; ulcers that have 
become irritable from topical treatment ; margins of tfre sore 
sharp, ragged and undermined, discharge thin, acrid, and offen- 
sive; the sore is painful, and liable to bleed copiously when 
touched ; svphilitic ulcers or disease in those who have been 



194 Surgical Diseases of the Penis, 

under mercurial treatment; vesicles or blisters on the prepuce 
burning of the labia; eruption of moist, copper-colored, or red 
spots ; burning eruption on the skin. 

Worse in the morning, forenoon, and periodically ; also, in the 
open air, on coughing, when getting heated, from talking, on being 
touched, and in getting warm in bed. 

Better from cold (?). Either side. 

CinnabariS. Sensitiveness of the head to the touch, even the 
hairs are sore; inflammation of the right eye, with itching, press- 
ing and pricking at the inner angle and lower lids ; constant lach- 
rymation on looking steadily, with profuse discharge of mucus from 
the nose ; redness of the whole eye, with swelling of the face ; 
small ulcer on the roof of the mouth, on the right side of the tip 
of the tongue, and on the tip ; swelling of the penis ; redness and 
swelling of the prepuce, with painful itching ; violent itching of 
the corona glandis, with profuse secretion of pus ; small shining 
red points on the glans ; blenorrhoea of the glans ; sycotic ex- 
crescences ; violent erections in the evening ; profuse perspiration 
between the thighs when walking ; general nervous, uneasy sen- 
sation. 

Worse in the evening, and at night ; also, after sleeping. 

Better in the open air. 

Conium mac. This is a useful remedy in cases similar to those 
in which we prescribe Arnica, and find no good result. Phimosis 
or paraphimosis caused or aggravated by contusions, succeeded 
* by inflammation, are very readily cured in many cases by this 
agent. Aversion to light, without inflammation of the eyes ; yel- 
lowish color of the eyes ; induration of the parotid gland ; puru- 
lent discharge from the nose ; sickly and pale complexion ; moist 
and spreading eruption on the face; gums swollen, blue-red, and 
bleed readily ; excessive pollutions ; humid tetters on the fore part 
of the arm ; red spots on the calves, which turn yellow or green. 

Worse at night, and periodically ; also, when standing, when at 
rest, and when lifting the affected part. 

Better when the affected part is hanging down, from motion, 
and when walking. Left side. 

Dulcamara. Herpes preputialis, bleeding ; brown, dry, humid 
or furfuraceous ; painful ; red, pale-red, or with a red areolar ; 
round, scaly, and small herpes ; suppurating, yellow herpes. 

Hepar sulphur. This is an invaluable remedy when the patient 



Special Therapeutics. 195 

comes to you second-hand, and has undergone a " brisk mercurial 
treatment ; " mercurial diseases of the gums ; pains in the bones ; 
chancres not painful, but disposed to bleed readily ; margins of 
the ulcers are elevated and spongy-looking, and no granulations 
in the center of them ; buboes following mercurial treatment, when 
the gums and mouth are inflamed and ulcerated ; phimosis with 
discharge of pus, accompanied by throbbing; the same condition 
in paraphimosis calls for it; itching of the penis, glans and 
frcenum ; ulcers like chancres on the prepuce ; humid soreness on 
the genitals, scrotum, and folds between the thigh and scrotum ; 
in herpes preputialis, when they are humid, inflamed and suppu- 
rating ; corroding eruption of pustules on the skin. 

Worse in the morning, forenoon and night ; also, when blowing 
the nose, from cold, when chewing, from moving, talking, swallow- 
ing, being touched, and before, during and after urinating. 

Better during perspiration, and on getting warm in bed. 
Right side. 

Kali bichromicum. The bones of the head feel sore ; stitches 
in the bones of the head, as if from a sharp needle ; eyelids burn- 
ing, inflamed, and much swollen; the albuginea of the eyes ap- 
pears puffy, with yellow-brown points like pin-heads; brown 
spots on the conjunctiva ; profuse secretion from the right nostril ; 
a spot on the right lachrymal bone is swollen and throbbing ; the 
septum ulcerates ; round ulcer in the septum ; pale yellowish com- 
plexion ; pain in one of the malar bones ; digging pain in the rami 
of the lower jaw ; ulcers with hard edges, smarting, on the mucous 
surface of the lips ; painful ulcer on the tongue ; deep excavated 
sore, with a reddish areola, containing a yellow tenacious matter 
at the root of the uvula; the fauces and palate presenting an 
erythematous blush ; in the fore part of the palate, are single cir- 
cumscribed spots, colored red, as if little ulcers were about to 
form ; ulcer on the roof of the mouth with sloughing ; ulceration 
of the uvula and tonsils ; itching in the hairy parts of the genitals ; 
the skin becomes inflamed, and small pustules of the size of a pin's 
head are formed ; constrictive pain at the root of the penis ; prick- 
ing and itching at the glans penis ; swelling' of the genitals in 
women ; rawness and soreness of the vagina ; periodical wander- 
ing pains all over the body ; small pustules over the body similar 
to small-pox ; they disappear without bursting ; pustules over the 
body or inflamed spots, as big as a pea, with a small black scab in 
the middle. 



196 Surgical Diseases of the Penis. 

Worse in the morning, and periodically ; also, in the open air, 
from cold, and during the summer. 

Better from heat. Right side. 

KreOSOte. Longing for death; low-spirited; painfulness of 
the scalp, with great falling off of the hair, the scalp is painful 
when brushing the hair ; livid complexion, with swelling of the 
cervical glands ; during micturition burning between the labia ; 
burning of the genitals, with impotence ; itching in the vagina, 
inducing rubbing in the evening, succeeded by swelling of the 
external parts, with soreness in the vagina when urinating. 

Worse in the morning ; also in the open air, and on moving. 

Better from warmth. 

Lachesis. Phagedcenic chancre; has proved useful in para- 
phimosis when the constriction causes gangrene, or threatened 
gangrene-eruption on the glans and mons veneris ; eruption of 
pimples on the genital organs ; chappy, itching eruption on the 
skin ; yellow color of the whites of the eyes ; redness .on the 
point of the nose ; scabs in the nose ; ulcers in the throat, and on 
the inflamed tonsils ; induration of the prepuce ; chancres badly 
treated with mercury ; redness and swelling of the external parts 
'with discharge of mucus in women ; excitement of the sexual 
desire in women ; caries of the tibia ; flat ulcers on the lower ex- 
tremities, with blue or purple areola ; gangrenous blisters, and 
ulcers ; purple spots on the skin. 

Worse in the evening and night, and periodically ; also, after 
sleep, and from alcoholic drinks. 

Better after eating. Left side. 

Lycopodium. Chancres with raised edges ; chancres with all 
the characters of an indolent ulcer, the margins thick, rounded 
and prominent, without the slightest appearance of granulations, 
or if there are any, of a flabby appearance ; burning of the 
vagina ; eruptions on the glans ; condylomata ; elevated, red, 
smarting eruptions on the genitals ; biting, burning, or painless 
eruption on the skin ; syphilitic ulcers in the mouth. 

Worse in the evening and at night ; also, during coition, from 
bodily exertion, from wet poultices, on being touched, on getting 
warm in bed, and while urinating. 

Better when moving the affected part, and when walking in the 
open air. Right side. 

Mercurius jodatus. Has been used with good success in cases 



Special Therapeutics. 197 

of threatened gangrene of the glans in paraphimosis. Depression 
of spirits ; the right side of the septum, and the right nostril are 
very sore and much swollen ; soreness of the bones of the face ; 
dull bruised pain in the right malar bone, radiating into the fore- 
head, and right side of the head, a small spot pulsates and burns 
like fire ; fine bright-red eruption on the roof of the mouth ; sharp 
shooting stitches in the end of the penis through the glans. 

Worse in the evening ; also, during rest, or passive motion. 

Better from steady pressure in some instances, active motion, or 
while exercising. Either side. 

MerClirillS COr. By Laurie, and many others, this remedy is 
considered almost a specific for venereal diseases. It is certainly 
a good remedy, but no medicine can be a specific. The symptoms 
given by Laurie are as follows : Torpid constitutions, followed by 
Sulphur if no benefit resulted ; excessive pain, swelling and in- 
flammation ; buboes when small, and neither excessively painful, 
nor much inflamed. Like all his indications, they are vague and 
unsatisfactory. Lippe and others, give the following : Swelling of 
the head and neck ; from the ear a discharge of fetid pus ; swell- 
ing and redness of the nose; ozcena ; discharge from the nose 
like glue, drying up in the posterior nares ; perforation of the sep- 
tum ; the gums swell, are covered with a false membrane, become 
gangrenous and bleed freely ; phagedenic ulcers in the mouth, 
or on the gums and throat, with fetid breath ; tonsils swollen, and 
covered with ulcers ; pharynx dark-red, and painful to contact ; 
violent erections, during sleep ; the whole arm up to the shoulder 
is much swollen, red, and covered with vesicles ; periostitis in the 
lower jaw, and necrosis of the upper jaw; swelling of the glands, 
generally. 

Worse in the evening, and at night. 

MerCUrilJS SOl. Itching eruptions, with burning after scratch- 
ing ; little red raised spots, with stinging-itching ; herpetic spots, 
and suppurating pustules ; eruption resembling greasy itch ; dry, 
rash-like, readily-bleeding eruption ; the linen receives a saffron 
tinge from the imperceptible exhalations of the body ; eruption on 
the head ; small elevated scabs between the hairs on the scalp ; 
humid eruption on the hairy scalp ; falling off of the hair ; in- 
flammation of both eyes ; dim-sightedness ; fungous excrescences 
in the ear ; swelling of the nose ; white clay-colored face ; yellow 
complexion ; yellow scurf on the face, with a discharge of fetid 



198 Surgical Diseases of the Penis 

moisture ; syphilitic spots and pustules on the face and forehead ; 
soft red swelling of the upper lip ; looseness of the teeth ; the 
gums recede from the teeth, and are sore and ulcerated ; swollen 
gums, which bleed easily on touching them ; ulcers and sores in 
the mouth, burning and smarting, particularly in the evening; 
ulcers in the throat ; constant desire to urinate ; burning in the 
urethra during micturition ; red, brown or bloody urine ; turbid, 
thick urine ; discharge of blood from the urethra ; inflammation 
and swelling of the prepuce ; nightly emission of semen, mixed 
with blood ; a number of small red vesicles behind the glans, 
changing to ulcers, which burst and discharge a yellowish-white, 
staining, strong-smelling matter ; pimples or tubercles on the labia ; 
little blotches and ulcers on the back, scapulae, and on the abdo- 
men ; herpetic eruption on the forearm ; small sores on the fin- 
gers ; herpes on the legs and thighs ; chancres with an indurated 
base and margin, secreting, or covered by a thin tenacious matter ; 
gonorrhceal phimosis, or chancre with phimosis ; blisters on the 
glans; burning of the penis; eruption on the prepuce; 1 condy- 
lomata on the prepuce ; dry, fine vesicular eruption on the geni- 
tals ; eruption on all the parts covered with hair, excepting the 
head ; itching eruption of pimples or pustules on the skin ; chan- 
cres on the glans, prepuce, mouth, and labia. 

Worse in the evening, and at night ; also, on blowing the nose, 
when moving, from perspiration, when swallowing, on getting warm 
in bed, and during and after urinating. 

Better from cold (?). Right side. 

Nitric acid. Easily takes cold ; emaciation; great thinness ; a 
sick feeling over the whole body ; epilepsy ; dryness and itching 
of the skin ; the hands and feet are swollen ; pimples, and dark 
freckles on the skin ; great weakness of memory ; vertigo ; falling 
off of the hair ; scurfy, itching, and humid eruption on the head ; 
swelling of the eyelids ; dark spots on the cornea ; photophobia ; 
the sight becomes dim, and objects appear dark ; redness, suppu- 
ration, and violent itching behind the ears ; difficulty of hearing ; 
soreness and bleeding of the inside of the nose; disagreeable 
smell in the nose ; yellow fetid discharge from the nose ; yellow- 
ness of the face, particularly around the eyes ; the bones of the 
face are painful ; a number of small pimples on the face, especi- 
ally on the forehead ; pimples on the hairy border of the temple ; 
pain and swelling of the submaxillary glands ; white swollen gums ; 



Special Therapeutics. 199 

ulcers in the mouth and fauces ; putrid smell from the mouth ; 
ulcers in the throat ; heat and dryness of the throat ; want of 
appetite ; great thirst continually ; or, excessive hunger, with lan- 
guor, and sweetish taste in the mouth ; sour eructations with nau- 
sea ; pressing, gnawing, pulsating, or burning in the stomach ; 
suppression of urine ; nightly desire to urinate ; smarting pain in 
the urethra, or sore pain in the tip of the glans ; pain in the whole 
urethra during micturition ; ulcer in the urethra ; itching of the 
glans ; red spots on the glans, becoming covered by scabs ; deep 
ulcer on the glans, with elevated, lead-colored, and extremely 
sensitive edges ; deficient sexual desire ; ulcer in the vagina, look- 
ing as if covered with a yellow pus, with a burning pain, or itch- 
ing ; copper-colored spots on the arms ; herpes between the fingers ; 
swelling of the fingers ; spreading vesicles on the feet ; itching 
mercurial herpes preputialis ; burning of the testicles ; burning 
eruptions ; painful eruptions ; condylomata on the glans and pre- 
puce oozing ; eruption of pimples on the skin ; syphilitic ulcers 
in the mouth. 

Worse in the evening, and at night ; also, during perspiration. 

Better when at rest. A useful remedy in mercurial cases. 
Left side (?). 

Petroleum. Itching herpes preputialis, especially when occur- 
ring in conjunction with gonorrhoea; an eruption on the glans; 
the scalp is very sensitive on both sides, and sore to the touch, 
followed by numbness, and very sore on scratching it ; discharge 
of pus and blood from the ear ; humid soreness behind the ears ; 
swelling of the nose, and discharge of pus, and pain at the root 
of it ; swelling of the submaxillary glands ; ulcers on the inner 
cheek, painful when closing the teeth; swelling of the gums, 
with stinging, burning pain when touching it ; red, sore and moist 
scrotum, and adjacent parts ; in women, soreness and moisture of 
the sexual organs ; brown or yellow spots on the arms ; blisters on 
the toes becoming ulcers. 

Worse morning, and in the evening ; also, from walking. 

Better from warmth. Right side. 

Phosphoric acid. Chancres with raised edges ; chancres like 
an indolent ulcer, edges thick, rounded and prominent ; no gran- 
ulation, or else, pale and flabby granulations ; herpes preputialis, 
which may be red, dry, humid, burning, corroding or itching; 
blisters on the glans; condylomata on the glans; moist, dry, or 



200 Surgical Diseases of the Penis, 

vesicular eruptions on the genital organs ; painful eruption of 
pimples on the skin. 

Worse in the morning, and evening; also, when chewing, on 
lying down, from talking, and during urination. 

Better from moving. Left side (?). 

Pulsatilla. When from some imprudence in eating or drink- 
ing, the sore which was previously doing well, has changed to a 
bad character again ; tumors on the scalp suppurating, and affecting 
the skull ; inflammation of the eye, with thick mucus ; flow 
of mucus or thick pus from the left ear ; ulceration of the exter- 
nal wing of the ear, emitting a watery humor ; green, fetid discharge 
from the nose ; itching and burning, on the inner and upper side 
of the prepuce ; burning in the testicles without swelling. 

Worse in the evening, and at night ; also, from heat, when lying 
down and from eating fat food. 

Better from cold, and when walking in the open air. Right 
side. 

RhllS toxicodendron. Blisters (vesicles) on the glans'; erup- 
tions on the glans, scrotum and prepuce; moist vesicular erup- 
tions on the genital organs ; burning eruptions on the skin ; erup- 
tions on the parts covered by hair, excepting the head ; itching 
eruption of pustules on the skin ; itching and burning pains in 
chancres. 

Worse in the morning ; also, from chewing, from cold, from 
bodily exertion, from lying down, from wet poultices. 

Better from motion, and from warmth. Right side. 

Sepia. Indolent chancres, that Lye. and Bhos. ac. are unable 
to cure ; burning or itching, humid or scurfy herpes preputialis ; 
chappy herpes, with a circular desquamation of the skin ; corrod- 
ing, dry herpes ; pricking, yellow suppurating herpes ; eruption on 
the glans and labia ; itching and dry eruptions on the genitals ; 
chappy eruption, or itching eruption of pimples on the skin; 
chancres on the glans and prepuce. 

Worse in the forenoon, and evening ; also, after coition, during 
perspiration, and on being touched. 

Better from bodily exertion. Either side. 

Silicea. Chancres, with raised edges ; also those that had been 
rendered irritable from the free use of topical stimulating treat- 
ment, inflamed, painful and irritable chancres, with a discolored, 
thin and bloody discharge, and absence of, or indistinct, granula- 



Special Therapeutics. 201 

tions ; painful eruptions on the mons veneris ; itching, moist, or 
dry eruptions of red pimples, or spots on the genitals ; corroding 
eruption on the skin. 

Worse at night ; also, from cold, and wet. 

Better from warmth. Right side. 

Staphisagria* Humid, scalding-itching, fetid eruption on the 
back part of the head, the sides of the head, and behind the ears, 
itching changes the place on scratching, but the eruption becomes 
more humid ; pressing, stinging and tearing pain in the bones, and 
in the periosteum on the cranium ; swelling up, and suppuration 
of the bones of the head; ulcerations in the nostrils, with scabs 
deep in the nose ; white and painful swelling, with ulceration of 
the gums ; excrescences and nodosities on the gums ; painful 
excrescence on the inside of the cheek ; soft, humid sycotic excres- 
cences on and behind the corona glandis ; in women the sexual 
organs are painfully sensitive, especially when sitting. 

Worse at night ; also, from touching the affected parts. 
Better in the forenoon. Right side. ' 

Sulphur. Eruptions on the skin, burning and itching ; her- 
petic spots on the chest and back ; dry, fetid and humid eruption 
on the scalp, with thick crust, yellow pus, and itching ; purulent 
mucus in the eyes ; inflammation and swelling of the nose ; dry 
ulcers in and on the nose ; pale face, with sunken eyes surrounded 
by blue margins ; painful eruption around the chin ; swelling of 
the gums ; hard swelling on the gums, discharging pus and blood ; 
complete loss of appetite, with a bitter or putrid taste in the 
mouth ; violent desire to urinate ; frequent micturition ; fetid 
urine ; burning in the forepart of the urethra during micturition ; 
stitches in the penis ; increased sexual desire ; deep ulcer on the 
glans and prepuce, with a pad-shaped border ; troublesome itch- 
ing of the vulva, with pimples all around ; ulcerated vesicles on 
the feet ; urticaria-like eruption on the thighs. 

Worse at night; also, on getting warm in bed, from bodily 
exertion, from talking, from wet poultices, and on touching the 
parts. 

Better from motion, from warmth, and in dry weather. Left 
side. 

Thuja OCCid. The scalp is very painful to the touch, especially 
the side on which he lies ; the whites of the eyes are blood red ; 
the eye must be very warmly covered, if uncovered it feels as if cold 



202 Surgical Diseases of the Penis. 

air was streaming into the head ; oozing from the right ear smell- 
ing like putrid meat ; nose red and hot ; red eruption on the nose, 
at times humid ; light brown blotches on the face ; flat white 
ulcers on the lips inside, and in the corners of the mouth ; gums 
swollen and inflamed, with dark-red streaks on them ; swelling of 
the prepuce, with inflammation of the glans ; sycotic excrescences 
on the frcenum and glans, which are oozing ; venereal verrucae on 
the penis. 

Worse in the morning, evening, and at night ; also, from cold, 
and the heat of the head. 

Better from warmth. Left side (?). 

Before dismissing the subject of treatment, let me say, tha* in 
Phagedenic chancres, when the remedies do not arrest the slough- 
ing process, we must have recourse to strong acid to sponge it 
out thoroughly ; of all the acids, Nitric is the best. 

In paraphimosis, of the recent acquired variety, an attempt 
must be made to replace the prepuce, and then give remedies to 
reduce the inflammation. Seize the body of the penis between 
the index and middle finger of the right hand, and draw it forward 
at the same time that pressure is made with the thumbs on the 
glans. 

Operations. 

The operations to be noticed, are only two in number, and are 
of very easy performance. In Phimosis, the old Jewish rite of 
circumcision, is often required. Seize the prepuce with a pair of 
forceps, draw it out as far as convenient, then seize it with another 
pair close to the glans ; then with one sweep of the knife, divide 
all the tissues. When the cut is completed, seize the edge of the 
mucous lining, and pass a stitch with fine silk or silver wire 
through it, making it fast to the external skin. By this means 
there will be no danger of a contracted cicatrix, or an adhesion 
between the cut surface anywhere. I think this procedure is orig- 
inal with myself. 

In paraphimosis, the prepuce is to be drawn back as far as pos- 
sible, and the edges divided on a director, in one or two places. 
Cut but a slight niche, and the force necessary to replace it 
in situ, will extend it far enough. The mucous membrane is to be 
stitched to the skin in the same manner as in phimosis. 



DISEASES OF THE BLADDER AND 
APPENDAGES. 



Diseases of the Prostate — Perineal Abscess — Urethri- 
tis — Gonorrhoea — Stricture of the Urethra — Cysti- 
tis — Tumors of the Bladder — Paralysis of Bladder — 
Calculi. 

Diseases of the Prostate Gland. 

The Prostate Gland is subject to several diseases. Among 
the more frequent or common ones, are inflammation, abscess, 
tumors, and hypertrophy. 

Prostatitis, like all the diseases of the gland, rarely occurs idio- 
pathically, and is most common in connection with, or as a 
sequence upon gonorrhoea ; the gonorrhceal complication is ex- 
ceedingly common. In forming a diagnosis of this class of dis- 
eases, the aid of the finger through the rectum is necessary. In 
this disease, there is pain deep-seated in the perineum, greatly 
increased when going to stool by the pressure of the faeces ; there 
is also pain while examining it, due to the pressure of the finger ; 
enlargement more or less, and finally a sense of weight in the 
perineum. In common with urethral and vesical diseases, there is 
frequent desire to urinate, with a spasmodic pain accompanying 
the act. As a pretty constant sign, there is much irritation of the 
neck of the bladder. Middle-aged men are more liable to this 
disease than those who are younger. 

Abscess of Prostate is a common sequence to inflammation of 
this gland, more especially if the inflammation be due to some 
injury. When suppuration sets in, the symptoms are similai to its 
invasion of other parts ; a chill more or less severe is succeeded 
by a remission or- total suspension of pain, followed by a throbbing 



204 Surgical Diseases of the Bladder, etc, 

or pulsating sensation, with an increased sensation of weight in 
the perineum, followed in turn by a dull, indistinct ache. Now, 
remedies we all know, may, and often do, cause a suspension of 
the suppuratory process, but like all mundane affairs, are liable to 
fail ; hence we must not trust to them, but make provision for an 
early and free evacuation of the pus, under the precautions men- 
tioned at the close of the chapter. In this disease, an amount of 
injury may be sustained by a spontaneous discharge of pus, that 
will prove irremediable, hence the importance of an artificial 
opening, cannot be too strongly impressed upon the mind. By 
perforation we may have a recto-urethral fistula, a fistula opening 
into the urethra alone, or into the rectum alone. All these troubles 
may be avoided by proper care. Suppuration is generally associ- 
ated with retention of urine, and in the introduction of the catheter 
to remedy this, it has frequently happened, that the abscess has 
been ruptured, and the very accident it should be our aim to avoid, 
has thus by carelessness been brought about. 

Tumors of the Prostate. — The urethral portion of the prostate, 
is frequently the seat of tumors of the fibrous or sarcomatous 
variety, constituting a very obscure, and hence almost incurable 
disease. Simple hypertrophy, in which the whole gland is enlarged, 
is only an aggravated case of sarcomatous enlargement, and 
hence, I am in the habit of speaking of only one tumor, the 
fibrous, preferring to consider the others as partial or lobular 
hypertrophy. It is of prime importance to keep the bladder com- 
paratively empty, as from the retention of urine caused by the 
pressure exerted by the enlarged gland, anasarca, extravasation, 
and a train of like diseases, are often brought about. As said be-* 
fore, it is usually the urethral portion of the gland that is so 
effected, while the rest may remain perfectly normal. Still I be- 
lieve there are one or two cases on record, in which the whole 
body of the gland has been more or less effected. Mr. Thomp- 
son, an English surgeon, as found in Erichsen, page 860, speaks 
of various kinds (3) of the prostate tumors, and from what he 
says, I am led to infer that they consist of modified true prostate 
tissue. One of them — the third — is composed entirely of nor- 
mal tissue found in the gland, and is a true partial hypertrophy. 
The symptoms of this condition, as well as true hypertrophy, are 
thus given by Erichsen : " The feeling of a necessity to strain 
slightly before the urine will flow ; and then after the bladder has 



Diseases of the Prostate Gland, 205 

been apparently emptied, the involuntary escape of a small quan- 
tity of water. The patient finds also, that he is much longer than 
usual in emptying the bladder, for though the stream flows easily 
enough so soon as it has begun to escape, yet it cannot be prop- 
erly projected, the viscus, having to a certain extent, lost its tonic- 
ity. About this time, changes begin to take place in the urine, 
which usually becomes somewhat fetid, though it continues acid, 
and is often intermixed with more or less viscid, stringy mucus, 
though in many cases it is clear, pale, and not in anyway altered 
in character. The symptoms often come on in a very gradual 
manner, the patient straining and experiencing much difficulty in 
the extrusion of the urine for months or even years, before reten- 
tion will occur. As the disease advances, and the bladder be- 
comes less capable of emptying itself, two or three ounces or 
more, of a residual urine are left, which becomes dark, mixed 
with adhesive, sticky mucus ; and, at last, if the mucous mem- 
brane of the bladder falls into a chronic state of inflammation, 
assumes a milky appearance from the admixture of pus, and be- 
comes horridly offensive, blackening the silver catheter." 

In hypertrophy, the same symptoms are of course observed. At 
the point in the urethra, corresponding to the enlarged position of 
the prostate, it will be found that the urethra has become enlarged, 
both in capacity and longitudinally. Erichsen tells us, that that 
portion of this canal which traverses the gland, has been found 
dilated into a pouch, capable of holding two or three ounces of 
urine, thus constituting a supernumerary bladder. In consequence 
of this elongation, the neck of the bladder will be found carried 
upwards and behind the pubes to a considerable extent. Any 
continued source of irritation predisposes to this condition, and 
among the most common we might enumerate gonorrhoea, stric- 
tures, and hard living. Until the flow of urine is considerably 
embarrassed by the enlargement, we cannot strictly call this con- 
dition a disease. Brodie, Guthrie, and Erichsen, and indeed 
nearly all European writers, consider hypertrophy as a condition 
peculiar to advanced age, that is after fifty, and so general is this 
belief held, that as Brodie says, "that period of life when the 
hair becomes gray, and scanty, when atheroma begins to be depos- 
ited in the coats of the arteries, and when the arcus senilis forms 
on the cornea, the prostate " is most likely to become increased 
in size. 



206 Surgical Diseases of the Bladder, etc. 

Perineal Abscess. 

Abscess in this situation is not uncommon ; it is usually the 
result of a kcik or a blow, but is sometimes seen after urethritis. 
When urethritis is neglected, or badly treated by old allopathy, 
such a result is very common. After an inflammation has been 
set up in this situation, a small spot is found to be soft, fluctuat- 
ing, and the skin over it has changed its hue. The treatment in 
such cases is almost exclusively instrumental. As the tissues are apt 
to be dense, and pus deeply seated, at the same time that it dis- 
charges through the skin, it will perforate the urethra. Hence, 
open it freely, and allow all the pus to escape. This had best be 
done under water, or in such a manner that the air may be ex- 
cluded from the sac ; use Calendula to close the wound, but I 
should use it internally. If all be true that is claimed for Carbolic 
acid, it will supercede anything we have now in use. Should 
signs of suppuration appear again after pus has once been evacu- 
ated, Merc, will probably dispel the danger ; but should pus form 
let it out as before. The neglect to do this, from the fact that 
spontaneous evacuation is effected by sloughing, may result in a 
urinary fistula. 

Urethritis. 

Urethritis, by some writers, is used synonymously with gonor- 
rhoea Though there is not much apparent difference between 
them, yet in reality they are far from being the same. Urethritis 
is a simple, non-venereal inflammation of the urethra, caused by 
cold, improper diet, some irritating influence, from a stricture, or 
from some abnormal condition of the urine. Like gonorrhoea, 
there is a discharge, but it is less in quantity, and not accompa- 
nied by as high a grade of inflammation. Women are frequently 
troubled with it, who are out of health, or are troubled with leu- 
corrhcea. In cases of a delicate nature, involving the chastity of 
man or woman, be very guarded in opinion ; if an opinion has to 
be given, rather prefer urethritis than gonorrhoea. 

Gonorrhoea. 

Gonorrhoea is a venereal disease, and differing from syphilis in 
every other respect. It cannot degenerate into syphilis nor can 



Gonorrhoea. 207 

syphilis proceed from it. Furthermore I do not believe that the 
two diseases can exist at the same time. 

It is infectious, readily communicable from one person to 
another, and not only depending (for infection) upon sexual inter- 
course, but may be produced by mere contact, from wearing the 
same clothes, from privy-seats, etc. It is characterized by an in- 
flammation of the urethra, which in the female not unfrequently 
spreads over all the mucous surface of the internal organs of gen- 
eration. It is usually an actual local disease for a short time, but 
soon becomes what is commonly called " general " or " constitu- 
tional." There are a multitude of ailments arising from this 
affection, and it will not be necessary to speak of them ; as they 
are identified with diseases of the same character arising from 
other causes, I will merely give the names. We have rheuma- 
tism, ophthalmia, orchitis, in some cases cystitis, inflammation of 
the nose, a number of skin diseases, impotence, etc. When the 
disease has been suppressed by cold, improper treatment, or the 
like, these secondary ailments are apt to show themselves. 

Erichsen, speaking of the symptoms, divides them into three 
groups, and in this order we will speak of them : 

1 st. Those "of the Incubative stage, or period of incubation." 
From three to five days after exposure, these symptoms declare 
themselves, as an itching, heat, and severe irritation of the organs. 
The meatus will be found swollen, red, and usually gaping, and 
when the glans is squeezed a drop or two of pus — like mucus — 
will be discharged. The commencement of this stage is within the 
time stated above usually, though it has been known to come on 
directly after infection, and again has been known to be protracted 
for ten or even fourteen days. It generally lasts for one or two days. 

2nd. The symptoms of the second "acute inflammatory stage." 
One of the most common symptoms of this stage is " chordee." In 
this the penis becomes painfully erected, and is curved or twisted 
in various ways ; the most common way is downwards. The other 
symptoms : discharge abundant of muco-purulent fluid of all 
shades of color, from white to yellow or green ; pain on urinat- 
ing ; constant, or increased, desire to micturate ; thin spiral stream 
of urine ; the whole penis red and inflamed ; urethra is swollen, 
and feels like a cord ; and as the lower portion of the urethra be- 
comes affected heat and weight in the anus and perineum will be 



208 Surgical Diseases of the Bladder, etc. 

complained of. This stage under old-school treatment lasts about 
a fortnight, under no treatment much less time perhaps. 

3d. The third, or "chronic inflammatory stage," is character- 
ized by a diminished discharge which becomes thinner and more 
watery, less inflammation, subsidence or modification of the uri- 
nary irritation, although there is smarting during micturition for 
some time. When this stage has been developed, it may, under 
bad treatment or neglect, run into a slight discharge of glairy 
mucus in drops, which has been known to last for years. This i e 
known as 11 gleet" It is claimed by many, that this is not commu- 
nicable, but it has been often proved that it is ; and more, will 
reproduce gonorrhoea. 

When treating a person, ensure no gratification of the sexual 
instincts, abstinence from hearty eating, drinking liquor or cof- 
fee, particularly — in opposition to the popular doctrine — make 
them avoid gin, and withal preserve as much quietness as possi- 
ble. From two to four days will sometimes suffice to effect a cure. 

Strictures of the Urethra. 

This is a partial or complete closure of the urethra at one or 
more points, which impedes, and, in some cases, prevents the 
flow of urine. Usually they are the result of inflammation, or 
injury. 

(a) Spasmodic Stricture is so similar, on a superficial examina- 
tion, to retention of urine from other causes, that it might readily 
be mistaken for some other urinary disease if the catheter be not 
employed. The introduction of this instrument, however, will at 
once decide the matter from the peculiar resistance offered to its 
passage. I can call no words to mind to express it so well as an 
"elastic resistance." It usually affects a considerable portion of 
the canal, and has, I believe, even been known to affect its whole 
length. Another point in forming the diagnosis will be, that while 
the catheter or bougie is passed into the bladder with compara- 
tive ease, it will be found much more difficult to withdraw it. 
This form of stricture consists in a spasmodic contraction of the 
few muscular fibres that enter into the formation of the canal, 
and may be produced, as Erichsen says, by a cold, partaking of 
acid or irritating food or drink, etc. This form is frequently met 
with among drunkards, but more especially among beer-drinkers 



Organic Strictures 209 

when it is frequently very severe in its character, and seems to 
take on a partially congested condition. 

(b) Organic Stricture may proceed from kicks, blows or bruises, 
long-continued inflammations, or from sloughing of some por- 
tions of its walls. It may appear in any part of the canal, and is 
more to be dreaded in its effects, if long-continued, than intense 
inflammation, according to Erichsen, who says : " Hence it is of 
great importance not to allow gleet to run on indefinitely," as 
gleet and gonorrhoea of long standing often produce this affection. 
The terms permeable or impermeable are used for distinguishing 
the amount of stricture. The terms are improper, if applied to 
urine alone, as the urine will find its way out of the bladder, if not 
by one passage by another; but an impermeable stricture as 
regards the passage of the catheter may very readily exist. These 
strictures alter the formation of the urethra in a wonderful man- 
ner, assuming almost any shape, and, indeed, almost any degree 
of rigidity. The canal may be narrowed from thickening of the 
walls, or drawn together by some of the muscular fibres ; and this 
condition may exist only on one side, or include the canal all 
around. Again, it consists in the formation of tough bands or 
bridles, extending backwards and forwards across the canal; 
usually, however, an organic stricture is a thickening of the walls 
from plastic effusion due to inflammation, and consequently quite 
amenable to internal treatment. Generally the feeling communi- 
cated to the operator in exploring a urethra in this condition, is 
what may be called an unyielding, gristly one ; though they may 
be quite yielding, but this is rare. The urethra becoming 
occluded in one place, a false passage is formed in another, and 
thus much annoyance may be experienced in using the catheter. 

(c) Congestive Stricture. — This is almost sufficiently described 
by its name. It is nothing more than a narrowing of the urinary 
canal from the effects of congestion of the mucous membrane. 
The spasmodic stricture is either preceded by, or accompanied 
by, this condition, and thus, in spite of Erichsen and other 
standard authorities, I cannot make up my mind that it is a 
very well marked separate variety of stricture. The symptoms 
are those of congestion generally, joined to those of stricture. 

14 



210 Surgical Diseases of the Bladder. 

Cystitis. 

This is an inflammation of one or more coals of the bladder, 
and may be either acute or chronic. When chronic, it is called 
by many " cys orrhcea," and by others " vesical catarrh ; " others, 
again, use both names, but attach a different meaning to each. 
For my own part I consider all the terms as applying to the same 
condition, only indicating the degree of disease. However, as the 
symptoms differ somewhat in each variety, we shall notice them 
under the three divisions. 

(a) Cystitis is an acute inflammation of the bladder. It is 
characterized by pain and swelling in the hypogastric region, the 
emission of urine painful and (or) obstructed, with more or less 
of tenesmus vesicae. Any one, or all, of the membranes may be 
affected, but the mucous coat is the one most commonly inflamed. 
The bladder is very irritable, and considerable pain is experienced 
on pressure over the organ ; considerable constitutional irritation 
is also present. The urine is found to be high - colored, mixed 
with pus or mucus, and frequently tinged with blood. The 
disease may terminate fatally, or pass into a chronic form and 
terminate by resolution. An autopsy, when death results, will in 
general reveal a state of inflammation passing into one of gan- 
grene ; diffuse peritonitis ; the formation of pus in the substance 
of the organ, or between it and the rectum ; more or less thicken- 
ing of the walls of the bladder; and in many cases an effusion of 
urine into the cavity of the pelvis, particularly when the disease is 
of traumatic origin. It is worthy of notice, that the idiopathic 
form of cystitis is very rare, nearly every case being the result 
of injury. 

One case I had which differed somewhat from that ordinarily 
seen. The inflammation terminated in gangrene, which also 
resulted in sloughing and entire destruction of the viscus, which, 
producing extravasation of urine into the cavity of the pelvis 
caused death by suppuration and peritonitis. 

(b) Cystorrh<ea. This is sometimes called " chronic cystitis," 
and is characterized by a copious discharge of mucus from the 
bladder, passing out with the urine, and generally attended with 
dysuria. The majority of the symptoms, therefore, are nearly 
identical with cystitis, only in a more aggravated form. The 
lining membrane of the bladder is the coat usually affected. 



Tumors of the Bladder. 2 1 1 

(c) Vesical Catarrh is very similar in many respects to the last 
mentioned. The symptoms are, a constant desire to urinate, the 
urine having an ammoniacal and fetid odor, mixed with a large 
quantity of stringy glutinous mucus, which gives it a turbid ap- 
pearance. On being allowed to stand it separates into two parts, 
the upper part being clear, but the lower is composed of a thick 
mucus or pus, which sticks tenaciously to the bottom of the vessel, 
and on being poured out hangs in long stringy masses from the 
edges. The urine is also frequently mixed with urinary deposits, 
commonly of the phosphatic variety. This condition is accom- 
panied by local irritation and constitutional debility. Death is 
often the result of this form, and the signs of its approach are 
thus described by Erichsen : " The tongue becoming brown, the 
pulse feeble, and these are usually associated with urinary poison- 
ing of the blood, the mental manifestations becoming dull and 
obscured, and the body emitting a strong urinous odor, and the 
skin a dense clammy sweat." 

Tumors of the Bladder. 

Tumors of the bladder are fungous or polypoid in their charac- 
ter, and may be also either benign or malignant. The symptoms 
often resemble stone so closely, that some of our most distinguished 
surgeons have made that error in forming a diagnosis. Usually 
the symptoms are, pain on urinating, tenesmus vesicae, bloody or 
high - colored urine, deposition of a sediment in the vessel, and 
lastly, a sudden stoppage of the stream when urinating. If it be 
malignant, the same, or nearly the same symptoms may be looked 
for, with an increased amount of general or constitutional disturb- 
ance. It often happens that these growths become encrusted 
with urinary deposits, and from this fact the click, supposed to be 
characteristic of stone, can readily be produced by introducing 
the sound. This deception is further increased in the case of 
polypi, and more particularly if the pedicle be long, by the sound 
apparently passing completely around the foreign body, just as it 
would if it were stone. Under these circumstances many people 
have been cut for stone, and the mistake not been' discovered 
until the bladder had been opened. Even if this operation has 
been performed under this mistaken diagnosis, it is not such a 
very mortifying occurrence, for the probabilities are, that when a 



212 Surgical Diseases of the Bladder, 

tumor has become so encrusted with deposits, and taken on other 
signs of stone, that no treatment but that of a mechanical nature 
would cure the case. Still, such a grave operation should seldom 
be attempted in such cases. Usually the diagnosis is sufficiently 
easy, from the fact that all the symptoms of stone are present, 
except the click on striking it with the sound. Again, the sound 
cannot be passed completely around it, from the obstruction of 
the pedicle, or attachment of other nature. Still, in opposition to 
what has been said above, this diagnosis may be complicated, as 
stone may be soft and give no click, or it may be encysted, and 
thus the sound cannot pass around it. But in the cancerous 
varieties, we have two good symptoms, and one of them is quite 
infallible. Bloody urine, but above all, the presence of cancer cells 
in the voided urine. 

Hematuria is a discharge of urine mixed with blood, or, more 
properly, of pure blood, and is a frequent accompaniment of these 
carcinomatous tumors. It may proceed from congestion of one 
or both of the kidneys, from intense inflammation of the bladder, 
or from some injury attended by the rupture of some one of the 
blood-vessels of this viscus. It has been met in some cases so 
profuse that the whole cavity of the bladder has been filled by a 
semi- solid clot. Under these circumstances it becomes necessary 
to break up the clot, and thoroughly cleanse out the bladder. 

Paralysis of the Bladder. 

This is a loss of power in a part or whole of the bladder. It 
may occur with retention of urine, or the opposite condition, 
incontinence, depending upon the part of the organ involved. 
When the body of the viscus retains its normal condition of 
health, and the neck has lost its contractility, incontinence results 
from inability to retain the urine. On the other hand, when the 
body is paralysed, and the neck is in a natural condition, from 
the want of power to expel the urine, retention occurs. The 
causes of paralysis are various, and may be any of those producing 
the same condition in other parts of the body. Thus, momentary, 
or temporary paralysis, may succeed after the organ has been 
over-distended for some time. Again, an injury may produce a like 
result, from some violence done directly to the nerves. Permanent 
paralysis, i. e., that which calls on outside or medicinal aid for its 



Paralysis of the Bladder. 213 

removal, and not capable of relieving itself, may be consequent 
upon old age, or result from some violent mental emotion, as 
anger, grief, joy, etc. What is commonly called incurable paraly- 
sis, comes from an injury sustained by the spinal cord, in which 
everything supplied by these nerves below the seat of injury becomes 
paralysed. The curability of this kind depends upon the nature 
of the injury sustained. If a sharp instrument severs the cord 
completely, no relief is probable ; but if pressure from a dislocated 
vertebra, or some tumor is the cause, removal of this pressure will 
often restore the lost functions to the paralysed parts. The 
apparent discharge of urine must not be considered as conclusively 
proving that there is no retention. In the summer of 1864 I had 
a case of an old gentleman, who, after a violent fit of anger, fell 
down completely paralyzed below the hips. He never suspected, 
nor would he believe, that there was a retention of urine, because, 
as he said, "the water is continually dripping away." On passing 
the catheter, the enormous quantity of half a gallon of urine was 
voided. 

The retention of urine from paralysis can be readily dis- 
tinguished from the same condition from other causes by the 
introduction of the catheter: when the urine runs out in a con- 
tinuous stream, without any force, merely running out of the 
catheter, there is surely paralysis of the body of the bladder. 
But it may run out with a decided impulse from the bladder, and 
there be still a paralysis of the neck of that organ. This con- 
dition is known by the constant dribbling, and by the absence 
of that slight resistance offered to the passage of the catheter by 
the neck of the bladder in a healthy condition. This resistance 
is very slight, and to an inexperienced surgeon would not be at 
all noticed. 

Long continued retention will prove very serious, and perhaps 
i fatal, if neglected; infiltration of urine, or, as in cystitis, urinary 
blood-poisoning may occur. Hence no physician or surgeon is 
justified in neglecting to use the catheter as often as occasion 
requires it, to relieve his patient. Prof. Trouss^eu says that 
anasarca had been frequently met with by him, resulting from 
over -distension of the bladder. Many others corroborate this, 
and declare that the introduction of the catheter will solve the 
question, as the dropsy disappears when the bladder is emptied. 
(Medical Investigator, vol. 11,/. 114.) 



214 Surgical Diseases of the Bladder. 

I cannot speak too strongly when I say the willful neglect to 
use the catheter in these cases is criminal, and mal - practice. I 
once knew a physician who made the silly boast that no instru- 
ment could be found in his office ; he allowed a patient to die 
from rupture of the bladder sooner than depart from his ridiculous 
views on the subject of mechanical treatment. 

Calculi. 

These are true stones, found in the bladder or some of the urinary 
canals or passages. They are formed by the crystalization of 
some of the urinary salts. They are met in any cavity where the 
urine can collect and, as it were, stagnate. 

(a) Renal Calculi, are irregular bodies, formed generally of uric 
acid, animal matter, and oxalate of lime. They are sometimes 
excessively painful. The symptoms generally are, pain in the 
kidneys, bloody or turbid urine, and the usual symptoms of inflam- 
mation of the kidneys. 

(b) Uretal Calculi are the same formation as the renal, and take 
their distinctive name only during their passage from the kidneys 
to the bladder. They commonly give rise to the most excruciating 
pain, which extends to the testicle of the same side, and 
is productive of numbness of the thighs in both sexes. There are 
cases, however, in which they do not cause any unpleasant symp- 
toms; unless they are large, rough, and fill up the cavity of the 
ureter, so as to obstruct the passage of the urine, they are 
usuall painless. Haemorrhage is often the result of one of these 
passages when the stones are jagged and rough, wounding the 
mucous membrane. If there be any apology for the use of 
morphia, chloroform, or ether, in the practice of medicine, as 
merely palliative treatment, it is certainly in cases of this kind. 
When there is any pain at all, it is usually of the most intense 
character, and I do not believe remedies do much good in miti- 
gating it. To be sure, we give remedies, but the pain ceases only 
when the passage of the stone is completed. 

(c) Vesical Calculi may be formed in the bladder, or may come 
from the kidneys. The symptoms are, a sense of weight in the 
perineum ; on changing the position there is often a feeling as if 
some body were rolling in the bladder; during micturition, a 
sudden stoppage of the stream ; bloody urine ; pain or itching at 



Calculi, 215 

the tip of the glans, are all among the common symptoms. It is 
probably as difficult to form a positive diagnosis in these cases as 
in any disease known to medicine or surgery; so many conditions 
resemble it in so many particulars, that too much caution cannot 
be exercised. All the symptoms must be added to those elicited 
by the use of the sound. They may be found singly, or two or 
three together ; and of all sizes, from that of a pea to that of a 
pigeon's egg. When small they are often expelled with the urine, 
or may lodge in the urethra, and in their new situation constitute 
the fourth variety, or the 

(d) Urethral Calculi. These are readily distinguished by the 
presence of a small movable tumor, the history of the case, and 
the use of a sound or catheter. Care must be taken not to push 
the stone back into the bladder, as it will probably there form a 
nucleus for a larger one. Remove with a pair of long forceps* 
or if far back use the proper urethral forceps. If nothing else 
will do, remove it by an incision. 

Dunglison has arranged the following table, which, as it gives 
the chemical composition and other facts of interest, has been 
deemed worthy of copying : 



2i6 Surgical Diseases of the Bladder 



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Special Therapeutics. 217 

The causes are obscure, and Erichsen rightly supposes they 
are constitutional. They seem to be more frequently met with 
in certain countries and regions than in others. People so dis- 
posed are liable to have the most trivial things culminate in stone. 
Thus, a clot of blood has served as the beginning for stone ; so, 
also, the fragments remaining after crushing a stone in lithotripsy, 
form, in some cases, perfect stones again. 

Treatment. — In regard to the treatment of the diseases 
mentioned in this chapter, I would say that they are all amenable 
to treatment with the higher potencies, just as other diseases are, 
with two exceptions. I refer to organic stricture, and stone. 
Many of our most eminent practitioners claim the same amount 
of success in their treatment however, as in any other, and I am 
unwilling to give a positive opinion pro or con. My own belief is, 
that in the case of stone, remedies may prevent the increase in 
size of an already existing stone, but cannot produce or promote 
a re - absorption. It would be well if those who attempt to deny 
this would consider the difficulty in telling positively when a stone 
is present ; for how can a man say he has cured stone when he 
cannot be certain there was ever a stone in the bladder? The 
remedies to be employed in these diseases are as follows : 

Acetic ac, Aeon., Ant. c, Apis, Am., Ars., Aur., Baryta, Bell. 
Borax, Bry., Calc. c, Cann., Cann. ind., Canth., Capsic, Carbo. v., 
Caust., Cham., Chin., Cinnamon, Clem., Cocc, Coff., Coloc, Con., 
Copai., Dig., Dulc, Erig. can., Pert ., Gelsem., Graph., Hell., Hepar., 
Ham., Hyos., Ign., Iod., Kali c, Lach., Lye, Merc, Nit. ac, Nux v., 
Opi., Petrol., Petros., Phos., Plat., Plumb., Puis., Rhus, Sarsap., 
Secale, Selen., Sil., Stan., Staph., Stramon., Sulph., Thuja, Verat., 
Zinc 

A clinical index of them may be arranged as follows : 
Prostatitis : Aeon., Apis., Cann., Lye, Merc 

Gonorrhoeal : Aeon., Calc, Canth., Cap., Graph., Merc* 

Puis., Rhus. 
Prostate : Abscess of : Hep., Merc, Sil. 

Tumors of: Aeon., Aur., Con., Cap., Merc, Nit. ac, Puis., 

Sulph., Thuja. 

Hypertrophy of: Aeon., Am., Cap., Merc 

from a stricture : Aeon., Bell., Bry., Hep. s., Merc y 

from a blow : Am., Con., Staph. 



§ 



218 Surgical Diseases of the Bladder. 

Prostate: Hypertrophy of: from mercury: Aur., Carb. v., Hep., 

Nit. ac, Thuja. 

from scrofula : Baryta, Calc, Sulph • 

idiopathic : Am., Plat., Sulph., Calc, lad., Staph. 

Urethretis: Aeon., Puis., Canth., Lye, Rhus, Bell., Apis. 
Gonorrhoea : Aeon., Apis., Am., Cann. ind., Capsie., Copai., Gel., 

Merc., Petros., Rhus., Selen. [Hale says : Cauloph, Hyd. 

Hamam., Iris, Erigeron, Senecio.] 
Gleet : (see Gonorrhoea), [Hale adds : Collinson, Hydrastis, 

Erigeron can., Silphium, Eupat. pur.~\ 
Stricture : Spasmodic : Canth., Carbo. v., Clem., Con., Cap., Dig., 

Lach., Lye., Nux v., Puis., Sulph. 

Spasmodic, in drunkards : Hum. lup., Nux v., Bell. 

Organic : Borax, Ars., Calc., Carbo. v., Graph., Petrol., 

Rhus, Sulph. 

Congestive : Aeon., Am., Bell., Canth., Con., Mere. [Hale : 



Hydrast. can.] 
Cystitis : Aeon., Ars., Calc, Canth., Dig., Dulc, Hyos., Nux v., 

Puis., Sulph., Ant. c, Caps., Carbo. v., Hell., Kali, Mere., 

Phos., Verat. [Hale : Hydrast., Erigeron, Verat. vir.] 
Tumors of. the Bladder: Acetic ac, Calc, Carbo. v., Secale. 
Hematuria: Am., Calc, Cinnam., Con., Erigeron, Staph. [Hale: 

Eupat., Hamam.] 
Paralysis of the Bladder: From a blow: Am., Con., Staph. 

From passion : Aeon., Cham., Coloc, Hyos.. Ign., Nux v., 

Phos., Puis., Staph. 

From fright : Aeon., Ign. 

From joy: Coff., Puis. 

From grief: Ign., Staph. 

From apoplexy : Am., Baryta., Bell., Nux v., Stan., Zinc. 

From debility, or loss of fluids: Baryta., Chin., Ferr., Sulph. 

From over - distension : Ars., Am., Canth. 

With incontinence : Caust., Puis., Rhus. 

With retention : Arn., Canth., Lye, Stram. 

With gangrene : Ars., Lach., Secale. 

With constipation : Bry., Carbo. v., Caust., Cocc, Hyos., 



Kali, Nux v., Opi., Plumb., Secale, Sulph., Zinc. [Hale: for 
paralysis in general : Gelsemin.] 
Calculi: Aeon., Am., Ars., Con., Hep., Lye, Sarsap., Sulpha 
Calc. c [Hale: Eupator. purpur.] 



Special Therapeutics. 219 

Acetic acid. This remedy should not be introduced, perhaps, 
but as said in one or two former chapters, it is highly spoken of 
by those who have used it empirically, in the treatment of cancer. 
I used it in one case of open cancer of the breast, but could not 
see that it exerted any curative influence. 

Aconite nap. Painful, anxious urging to urinate ; difficult and 
scanty emissions of urine; brown, burning urine, with brick - 
colored sediment ; burning and tenesmus of the neck of the 
bladder; itching of the prepuce; pinching and piercing in the 
glans on urinating; pain in the scrotum, as if contused; tingling 
of the genitals ; increased sexual desire. 

Worse in the night; also, when in a warm room. 

Better in the open air, and when sitting still. 

Antimonilim Crild. Increased and frequent discharge of urine 
at night, with discharge of mucus, burning in the urethra, and 
pain in the small of the back. 

Worse at night; also, after eating, from bathing, and in the sun. 

Better during rest, and in the open air. 

Apis mel. Strangury; urine scanty, and high-colored; too 
profuse discharge of urine ; burning and smarting in the urethra, 
as if it were scalded ; burning and stinging in the urethra ; sexual 
desire increased. 

Worse in the morning, evening, and at night; also, from heat, 
especially in a warm room. 

Better from the application of cold water. 

Arnica montana. Tenesmus from spasms of the neck of the 
bladder; involuntary discharge of urine at night, when asleep, and 
during the day, when running; urine brown -red, with brick -dust 
sediment ; bloody urine ; frequent micturition of pale urine ; pain- 
ful swelling of the spermatic cord, with stitches in the abdomen. 
Worse in the morning. 

Better from motion. 

Arsenicum alb. Suppressed, or difficult micturition ; urine is 
bloody and burning ; involuntary discharge of burning urine ; 
urine is turbid and greenish ; dark brown urine, which is turbid 
when leaving the bladder, and does not become clear by standing; 
sometimes deposits a slimy sediment ; hcematuria during mic- 
turition ; burning during micturition, sometimes at the commence- 
ment only ; contracting pain in the left groin ; biting and tearing 
in the urethra; corrosive itching of the penis ; excessively painful 



220 Surgical Diseases of the Bladder, 

swelling of the genitals, with inflammation ; discharge of prostatic 
fluid during stool ; useful in threatened gangrene, or the invasion 
of suppuration. 

Worse at night ; also, from cold. 

Better from warmth in general. 

Alirum met. Painful retention of urine, with pressure in the 
bladder; passes more urine than corresponds to the quantity of 
water he drinks ; increase of sexual desire ; suicidal monomania is 
very marked (in gonorrhceal orchitis). 

Worse in the morning, and at night ; also, from cold, and while 
reposing. 

Better from moving, when walking, and on getting warm. 

Baryta carb. Supposed by some to be useful in tumors of, 
and hypertrophy of the prostate, but I have never derived the 
least benefit from its use. 

Belladonna. Retention of urine ; difficult discharge of urine, 
and then a discharge of a few drops of bloody urine only ; urine 
is scanty, fiery -red, or dark and turbid; continuous dropping of 
urine ; paralysis of the sphincter vesicae ; stricture of the urethra ; 
stitches in female sexual organs, with dryness of the vagina. 

Worse in the afternoon, evening, and at night ; on moving, on 
touching the parts. 

Better while standing. 

Borax. Frequent discharge of acrid - smelling urine ; very 
much used in organic stricture of the urethra. 

Bryonia alba. Diminished secretion of hot, red urine; white 
and turbid urine; burning in the urethra when not urinating; 
cutting in the urethra, or sensation of constriction when urinating ; 
while sitting, stitches in the testicles. 

Worse in the evening; also, from motion, and from heat. 

Better while lying down, and on getting warm in bed. 

Calcarea Carbonica. Chronic cystitis; dark -brown urine, 
with white sediment; burning in the urethra during urination; 
urine with a bloody sediment ; bloody urine ; fetid or pungent 
smell to the urine, which is very clear and pale ; acrid smell to 
the urine. 

Worse in the morning, and in the evening ; also, in wet weather, 
and in the cold air. 

Better from drawing up the limbs. 

Cannabis sat. Painful discharge of drops of bloody urine ; 






Special Therapeutics, 221 

lacerating as if in the fibers of the urethra ; itching, tingling 
stitches in the fore part of the urethra; burning stitches in the 
back part of the urethra during urination ; pain during micturition 
from the meatus to the bladder ; darting stitches in the urethra 
when standing ; the urethra is painful on touching it, through the 
whole length; priapism, and chordee followed by stitches in the 
urethra ; painful discharge of mucus ; no sexual desire ; the 
prepuce itches, and is dark - red, hot, and inflamed ; continuous 
burning of the whole prepuce and glans ; when walking the penis 
feels sore and burnt ; sense of pressure in the testicles, a sort of 
dragging when standing ; corrosive burning and stinging of the 
outer parts of the prepuce, edges of the glans, and of the meatus ; 
tensive pain in the spermatic cord when standing, with contraction 
of the scrotum. 

Worse in the forenoon, and at night ; also, when standing, and 
on urinating. 

Better when lying down. 

Cannabis indica. This remedy I have used a great deal, and 
with good success, when the symptoms were as follows : gonor- 
rhoea, unaccompanied by pain ; slight tingling, with inflammation 
around the meatus ; also a slight burning during micturition ; the 
discharge is yellowish - white, and very profuse. These symptoms 
are those that I have often cured with the remedy, and are given 
on my own authority. To them I would add one that does not 
often occur in gonorrhoea, but is a good " key - note " for the 
remedy : a feeling of intoxication, light - headedness, inability to 
fix the mind upon anything; objects appear distinct, out as if a 
long way off. 

CantharideS. Violent cutting in the urethra, before and after 
micturition, so excessive that the patient is obliged to bend double 
and scream ; haemorrhage from, with violent cutting pain in the 
urethra ; painful emission of a few hot drops of urine ; violent and 
excessive pain in the bladder ; heat and burning in the bladder ; 
pain in the neck of the bladder; paralysis of the neck of the 
bladder; suppression and retention of urine ; constant and violent 
desire to urinate, with a painful emission of only a few drops ; 
tenesmus and strangury of the bladder, with discharge of drops 
of blood; frequent micturition, sometimes scanty, sometimes pro- 
fuse discharge ; red, or bloody urine ; painful passage of urine, 
with much tenesmus, and either mixed with sand, full of mucus 
or hot and turbid ; bloody discharge from the urethra. 



222 Surgical Diseases of the Bladder. 

Worse in the afternoon, and at night; also, from drinking 
coffee. 

Better when lying down. 

Capsicum an. Tenesmus of the bladder; frequent unsuc- 
cessful desire to urinate ; burning urine, with burning-smarting in 
the urethra after urinating; the urethra is painful to the touch; 
urine deposits a white sediment ; violent erections and white sedi- 
ment in the morning early; chordee which can only be appeased 
or subdued in cold water ; purulent discharge from the urethra ; 
impotence. 

Worse in the evening and at night ; also on beginning to exercise. 

Better from continued exercise. 

CarDO Veg. Greatly diminished emission of urine ; great desire 
to urinate, the urine, however, passing off very slowly; dark-red 
urine, as if mixed with blood ; burning or smarting in the urethra 
when urinating; lacerating or drawing in the urethra after urinat- 
ing; acrid smell to the urine; reddish turbid urine; the urine 
deposits gravel, or red sediment. . 

Worse in the morning, and forenoon ; also from cold, and in 
wet weather. 

Better from lying down, and on loosening the garments. 

CaUStiCUITl. Frequent and urgent desire to urinate, with thirst, 
and scanty emission; involuntary emission of urine by day and 
night; at night when asleep, when coughing, sneezing or walking, 
an involuntary emission of urine; burning in the urethra when 
urinating ; itching of the orifice of the urethra . 

Worse in the evening ; also in the open air. 

Better from heat, and when in bed. 

Chamomilla. Ineffectual urging, with anguish during micturi- 
tion; the urine is hot, with flocculent sediment; turbid urine; 
smarting pain in the urethra, during micturition ; itching, stinging 
pain in the margin of the prepuce ; soreness of the border of the 
prepuce ; excited sexual desire. 

Worse at night ; also from the heat of the bed, and after taking 

cold. 

Better after perspiration, and on rising from the bed. 

China Off. Urine is dark, turbid and scanty; scanty urine, of 
a greenish-yellow color, and with a brick-dust sediment; frequent 
micturition; burning at the orifice of the urethra, especially pain- 
ful if the clothes rub against the parts; stitches in the urethra; 






Special Therapeutics. 223 

sexual desire excited, with lascivious fancies ; impotence, with 
excited lascivious fancy. 

Worse at night ; also from touching the parts, however softly. 

Better on rising from the bed. 

Cinnamon. This remedy is used in haematuria a great deal by 
some, but, I believe, its use is altogether empirical. 

Clematis erecta. Long-lasting contraction, and constriction 
in the urethra; spasmodic stricture, in which the urine is only 
emitted drop by drop ; frequent micturition, but little at a time ; 
great burning at the commencement of urination ; painful drawing 
in the spermatic cord, when urinating; the urethra is painful to 
the touch. 

Worse at night ; also from the heat of the bed. 

CoCCUlllS ind. Tensive aching pain in the orifice of the urethra, 
between the acts of micturition; also itching and stinging near 
the fossa navicularis; frequent desire to urinate, with small dis- 
charges ; watery, pale urine ; increased excitability of the genitals 
in men. 

Worse in the evening; also from eating, and sleeping. 

Coffea Crilda. The sexual organs are very much excited, but 
without emission of semen ; emission of a large quantity of urine 
at midnight. 

Worse in the morning, -and at night ; also in the open air. 

Better from cold water applications. 

ColOCynthis. Frequent tenesmus vesicae, with but small dis- 
charges; urine is foetid, soon thickens, and is viscid, like jelly; 
abundant micturition ; urine of a faint, flesh color, with a white- 
brown, flocculent, transparent sediment, depositing on the chamber 
small, red, hard, solid crystals, which adhere firmly to the vessel ; 
itching of the orifice of the urethra, with desire to urinate ; burn- 
in the urethra after micturition ; retraction of the prepuce behind 
the glans during sleep ; impotence. 

Worse in the afternoon, and in the evening ; also from motion. 

Better from bending double, and (temporarily) from drinking 
coffee. 

Conilim mac. Urgent desire to urinate, every half hour; cutting 
pain in the urethra when emitting the urine ; sharp pressing in the 
bladder, and burning in the urethra ; strangury ; the flow of urine 
suddenly stops, and continues after a short interruption ; the urine 
is thick, white and turbid ; bloody urine ; after urinating, burning 



224 Surgical Diseases of the Bladder* 

in the urethra, and pressure in the neck of the bladder with stitches ; 
pressure on the bladder; frequent micturition during the night, 
it cannot be retained. 

Worse in the morning, and at night ; also while standing, when 
at rest, and from masturbation. 

Better from moving, and when walking. 

Copaiva Off. Constant weakness of the sexual organs ; loss of 
sexual desire; burning and sensation of dryness in the region of 
the prostate gland, and in the urethra ; induration of the prostate 
gland, and great pain in it on urinating ; yellow purulent gonor- 
rhoea; itching, biting and burning in the urethra, both before and 
after urination ; constant, though ineffectual desire to urinate ; 
retention of urine. 

Digitalis piirp. Pressure on the bladder ; violent unsuccessful 
desire to urinate; continued desire to urinate, only a few drops 
being emitted each time ; the urine is dark-brown, hot, and burns 
on being passed ; contractive pain in the bladder during micturition ; 
pressing and burning in the centre of the urethra on urinating ; 
acrid urine ; alternation of diminished secretion of urine, with 
copious secretion of watery urine; enuresis with vomiting and 
diarrhoea. 

Worse from getting heated, and on moving. 

Better when sitting down. 

Dulcamara. Urine turbid and white; strangury; painful 
micturition ; chronic cystitis ; constant desire to urinate, with an 
unpleasant sensation of bearing down towards the vesical region 
and urethra; emission of urine, drop by drop, which deposits a 
slimy sediment ; urine mixed with sanguinolent corpuscles ; turbid 
or white urine ; sediment in the urine sometimes white, and again 
red ; red and burning urine ; enuresis. 

Worse in the evening; also when at rest, from cold, and in wet 
weather. 

Better from moving about, and in a warm air. 

Erigeron Can. An excellent remedy for haemorrhages from the 
bladder or urethra. Like many of the " New Remedies," it has 
only been used empirically. 

Ferriim met. Discharge of mucus from the urethra after a 
cold; involuntary micturition, particularly in the day time; noc- 
turnal emissions ; swelling and indurations in the vagina. 

Worse in the morning, and the latter part of the night; also 
when at rest. 






Special Therapeutics. 225 

Better from slow exercise. 

Gelseminum nitid. Frequent micturition; genitals (in men) 
cold and relaxed ; involuntary emissions with erections ; painful 
redness of the urethra; Dr. Douglas, of South Carolina, records 
a case in the " Review," of gonorrhoea of several months stand- 
ing being cured by this remedy ; as it has been copied in every- 
thing written on this subject since that time, it is unnecessary to 
quote it here. It is used empirically a great deal. 

Graphites. Anxious, painful desire to urinate, with discharge 
of small quantities of brown urine in drops, with a stitch in the 
urethra when emitting it ; sour-smelling urine ; the urine becomes 
very turbid, with a reddish sediment ; during micturition pain in 
the os sacrum ; wetting the bed at night ; nightly desire to urinate ; 
frequent micturition ; in men, tension and lascivious feelings in 
the genitals ; voluptuous irritation of the genital organs ; immod- 
erate sexual desire, with violent erections ; dropsical swelling of 
the prepuce and scrotum ; soreness of the vagina. 

Worse at night ; also from cold. 

HelleborUS nig. Frequent desire to micturate, emitting but 
a small quantity ; dark urine, feeble stream ; a large quantity of 
pale, watery urine is emitted; suppressed sexual desire. 

Worse in the evening; also in the cold air, and from bodily 
exertion. 

Better in the warm air. In the open air he feels better, but as 
if he had been sick a long time. 

Hepar SUlph. The urine is passed slowly, with difficulty, and 
drops out perpendicularly; sharp, burning urine, corroding the 
prepuce ; burning in the urethra during micturition ; urine dark- 
red, hot ; bloody urine ; stitches in the urethra ; inflammation and 
redness of the orifice of the urethra ; discharge of mucus from the 
urethra; wetting the bed at night; itching of the glans and frenu- 
lum ; diminished sexual instinct, with feeble erections ; discharge 
of prostatic fluid after urinating. 

Worse at night; also from cold air, from pressure, and on 
touching the part. 

Better from warmth, and wrapping up warmly. 

Humulus llip. Has been used with good success in retention 
of urine in drunkards, particularly in beer-drinkers. 

Hyoscyamus nig. This remedy is particularly useful in the 
beginning of an attack of cystitis, when, although there is of course 
15 



226 Surgical Diseases of the Bladder, 

some inflammation of the organs, the principal trouble is a diffi- 
culty in urinating from a spasmodic constriction of the neck of 
the bladder. The symptoms in other cases and diseases, are as 
follows : frequent desire to urinate, with scanty discharges ; invol- 
untary micturition, as from paralysis of the bladder; retention of 
urine, with pressure in the bladder; frequent emission of urine, 
clear as water. 

Worse in the evening ; also after eating or drinking, and during 
menstruation. 

Better on stooping. 

Ignatia amara. Sudden and irresistible desire to urinate; 
frequent discharge of watery urine; pressure to urinate from 
drinking coffee ; burning and smarting in the urethra during mic- 
turition ; itching in the fore part of the urethra ; violent itching of 
the genitals in the evening, relieved by scratching ; lasciviousness 
without erections; contractions of the penis, it becomes quite 
small ; perspiration on the scrotum. 

Worse in the afternoon and evening ; also from tobacco, coffee 
and brandy. 

Better by lying down (on the back) or changing the position. 

lodilim. Retention of urine; urine yellowish-green, or acrid; 
dark, turbid or milky ; or, with a variegated cuticle on its surface ; 
increase of sexual desire. 

Worse at night, and in the evening; also from pressure or 
warmth, and when walking quickly. 

Better from cold. 

Kali Carb. Frequent micturition, with discharge of small quan- 
tities of fiery urine; burning in the urethra, during and after 
micturition; the urine is discharged slowly; after micturition, 
discharge of prostatic fluid ; sexual desire excessive, or deficient. 
Worse in the morning: also from cold air. 

Better on getting warm. 

Lachesis. Burning during micturition ; frequent micturition, 
with a copious emission of foaming urine ; yellow urine ; sensation 
as if a ball were rolling in the bladder ; great excitement of the 
sexual desire; redness and swelling of the pudenda, with dis- 
charge of mucus; sexual desire strong (in women.) 

Worse in the evening; also after sleep, and from alcoholic 
drinks. 

Lycopodium. Frequent emission of foamy urine ; dark urine, 



Special Therapeutics. 227 

with burning; hemorrhage from the urethra, without pain, also 
with lameness of the lower limbs, and constipation; burning in 
the female urethra during micturition; itching in the urethra 
during or after micturition ; violent, but short, pain of a drawing 
character, in the forepart of the urethra ; stitches in the bladder ; 
dark urine, with diminished discharge ; stitches in the neck of the 
bladder, and in the anus, at the same time; renal colic; sexual 
desire increased, or suppressed; impotence, the penis being small, 
cold, and relaxed ; feeble erections ; itching of the internal surface 
of the prepuce; dryness of the vagina; burning in the vagina 
during coition ; varices on the genitals of women. 

Worse in the afternoon and evening ; also when lying down or 
sitting, from cold food or drink, and from pressure of the clothes. 

Better on getting cold, and from warm food and drink. 

MerCUrillS. Constant desire to urinate, with no emission, or 
red and brown urine, extremely turbid, and smelling sour ; scanty 
fiery-red urine, or dark urine, as if mixed with blood ; greenish 
gonorrhceal discharge, especially at night; inflammation of the 
prepuce, with considerable swelling, and burning pain, as if it were 
distended with water or air; drawing pain in the groin, and a 
similar pain in the spermatic cord ; hard swelling of the testicle, 
with shining redness of the scrotum ; hemorrhage from the urethra. 

Worse in the evening, and at night ; also from the heat of the 
bed, and when exercising. 

Better when at rest, when lying down. 

Nitric acid. Nightly desire to urinate, with cutting pain in the 
abdomen ; foetid or greenish urine ; burning in the urethra during 
micturition, with violent pain after ; smarting pain in the urethra, 
or sore pain in the meatus during urination ; yellowish or bloody 
gonorrhceal discharge ; frequent itching of the glans ; inflam- 
mation and swelling of the prepuce, with burning pain ; violent 
itching of the scrotum, with violent pain in the testicles ; deficient 
sexual desire ; chordee ; erections with burning or stitches in the 
urethra ; suppression of urine, without pain ; stricture resulting 
from gonorrhoea or syphilis ; discharge of bloody mucus from the 
urethra. 

Worse in the evening, and at night; also from touching the 
parts. 

NlIX vomica. Pressing pain in the meatus, between the acts of 
micturition, accompanied by shuddering ; sharp pressure as with 



228 Surgical Diseases of the Bladder. 

a cutting instrument, in the forepart of the urethra, also at the 
bladder, perineum, and anus, with contractive pain between the 
acts of micturition, and discharge of mucus ; painful ineffectual 
desire to urinate ; nightly urging to urinate, terminating in dis- 
charge of blood, and severe burning ; burning and lacerating pain 
in the neck of the bladder; burning in the urethra (or itching) 
during micturition ; contractive pain in the urethra, after urinating ; 
the urine is discharged drop by drop; discharge of pale urine, 
which is followed by thick, whitish, purulent matter, with a burn- 
ing pain ; reddish urine, with a brick-dust sediment. 

Worse in the morning ; also from motion, and being touched. 

Better from strong pressure. 

Opium. Suppression of urine, as from contraction or paralysis 
of the bladder; scanty, dark-brown urine, with brick-dust sedi- 
ment ; excitement of the sexual organs, and violent erections ; 
haematuria; impotence. 

Worse at night ; also from brandy or wine, and after sleep, 

Petroleum. Frequent micturition ; burning urine, with a white 
sediment ; burning in the neck of the bladder when urinating ; a 
very violent contraction in the region of the bladder; burning 
pain in the urethra ; constant dripping of urine ; frequent mictu- 
rition, with scanty emission of brown, foetid urine ; soreness of, 
and moisture on the female genitals. 

Worse in the morning, and evening ; and also after walking in 
the open air. 

Better in warm air. 

Petroselinum. Agglutination of the orifice of the urethra by 
mucus; albuminous yellow discharge from the urethra; during 
micturition, burning and tingling from the perineum through the 
whole urethra ; drawing, afterwards itching, in the fossa navicu- 
laris ; tingling in the urethra, followed by pressure in the region 
of Cowper's glands ; priapism, but without chordee. 

Phosphorus. Increased secretion of watery pale urine; fre- 
quent micturition, but a small quantity each time ; haematuria ; 
urine whitish, like curdled milk, soon becoming turbid with brick- 
dust sediment, and with a variegated cuticle on the surface ; 
twitching and burning in the urethra, with frequent desire to 
urinate ; involuntary discharge of urine ; sexual desire increased, 
with irresistible desire for coition ; impotence ; stiches upward in 
the vagina, into the pelvis. 



Special Therapeutics. 229 

Worse in the evening, and at night; also when lying on the 
back, and on rising from the seat. 

Better from rubbing, after sleeping, and from eating something 
cold. 

PlatinutYl met. Frequent micturition, with slow flow of urine; 
red with white clouds, or turbid with red sediment; the sexual 
desire is unnaturally increased, with violent erections, especially 
at night ; in women, painful sensitiveness of the genitals, inter- 
nally and externally; unnatural excitement of the sexual desire, 
with voluptuous tingling in the internal and external sexual organs. 

Worse in the evening ; also when at rest. 

Better during motion. 

Plumbum met. Difficult emission of urine, only by drops; 
strangury ; hematuria ; genitals swollen and inflamed ; increased 
sexual desire, with violent erections. 
Worse at night. 

Better from rubbing. 

Pulsatilla. Strictures of the urethra, from suppressed gonor- 
rhoea ; retention and incontinence of urine ; frequent desire to 
urinate, with drawing in the abdomen ; colorless, watery urine ; 
cystitis which is due to suppressed menstruation; painful and 
scanty emission of slimy and sanguinolent urine, which deposits 
a purulent-looking sediment ; burning and cutting pains in the 
hypogastrium, with external heat, and tumefaction ; suppression 
of urine; thick gonorrhceic discharge from the urethra; sexual 
desire too strong ; itching-burning on the inner and upper side of 
the prepuce ; burning in the testicles without swelling. 

Worse in the evening; also from imprudent eating, and from 
warmth. t 

Better from cold, and when in the open air. 

Rhus tox. Retention of urine; discharge of drops of bloody 
urine, attended with tenesmus ; hot, dark urine ; diminished secre- 
tion of urine, although he drinks much ; the urine is emitted in a 
dividing stream ; swelling of the glands and prepuce ; prepuce 
dark-red ; stinging-itching on the inner surface of the prepuce ; 
violent erections at night, with urging to urinate ; soreness and 
stitches in the vagina. 

Worse in the morning; also when at rest, from change of 
weather, and from cold. 

Better from motion, and warmth. 



230 Surgical Diseases of the Bladder. 



Sarsaparilla. Frequent ineffectual urging to urinate ; dimin- 
ished secretion of urine ; tenesmus of the bladder, with discharge 
white, acrid, pus and mucus : painful constriction of the bladder ; 
frequent profuse discharge of pale urine, without any sensation in 
the urethra; burning in the urethra during every micturition; urine 
red and fiery, or turbid, containing long flakes; at the end of 
micturition some blood passes ; sand in the urine in large quanti- 
ties ; bad effects from gonorrhoea suppressed by mercury. 

Better from warmth. 

Secale COP. Suppression of urine ; pale, watery urine ; hemor- 
rhage from the urethra. 

Worse at night ; also from touching the parts, from warmth, and 
on getting warm in bed. 

Better in the cold air and when standing. 

Selenium. Red, sandy, coarse-grained, or brick-dust sediment 
in the urine; itching of the scrotum; erections, with much itching 
in the urethra ; diminished sexual desire, or impotence with sexual 
desire. 

Worse in the afternoon, and- at night; also after sleep, and from 
salt food. 

SHicea. Desire to urinate, with scanty emission and smarting 
in the urethra ; pressure on the bladder when urinating, with sub- 
sequent burning; redness of the prepuce near the corona, as if 
excoriated ; desire to urinate, with sometimes scanty emission, and 
again a copious flow; sediment of red sand, or deposit of yellow 
sand; increased sexual desire, with frequent violent erections. 

Worse in the night ; also in the open air, from cold, from exter- 
nal pressure, and from drinking wine. 

Better from warmth. p 

Stannum met, Scanty secretion of urine ; the urging to urinate 
is wanting, as if there were no sensation in the bladder, only a 
sensation of fullness indicates the necessity to urinate ; increased 
sexual desire. 

Worse in the evening; also during rest. 

Better when walking. 

Staphisagria. Frequent urging to urinate, with scanty dis- 
charge in a thin stream ; or discharge of dark urine by drops ; 
profuse discharge of watery, pale urine with much urging; during, 
and after micturition, burning in the urethra; after micturition 
urging as if the bladder were not emptied; excitement of the 



Special Therapeutics, 231 

sexual instinct; in women, painful sensitiveness of the sexual 
organs, especially when sitting. 

Worse in the morning, forenoon, and at night ; also from touch- 
ing the parts, and from tobacco. 

Stramonium. Suppressed secretion of urine ; involuntary urina- 
tion ; the urine is only discharged in drops, with constant painful 
urging. 

Worse in the morning; also from being touched. 

Sulphur. Retention of urine; frequent micturition, especially 
at night ; discharge of urine only by drops ; involuntary discharge 
of urine only at night ; burning in the orifice of the urethra during 
micturition ; foetid urine, with greasy pellicle on it ; hemorrhage 
from the urethra; stitches in the bladder; cutting pain in the 
urethra when urinating ; redness and inflammation of the orifice 
of the urethra; discharge of mucus from the urethra; secondary 
gonorrhoea; coldness of the penis, with weak sexual powers, and 
impotence; stitches in the penis. 

Worse in the evening, and during the latter part of the night ; 
also from bodily exertion, on getting warm in bed, when standing, 
from touching the parts, and from water and washing. 

Better during motion, from heat, and in dry weather. 

Thuja OCCi. Frequent urging to urinate, with profuse secretion 
of urine, especially towards and in the evening ; foaming urine, the 
foam remaining long on the urine ; dropping of urine after having 
urinated ; the bladder feels paralyzed, having no power to expel ; 
sediment of brown mucus ; burning, or biting-itching in the 
urethra ; urine contains sugar ; bloody urine : swelling of the 
prepuce, with inflammation of the glans ; copious watery dis- 
charge from the urethra ; stitches in the urethra, with urging to 
urinate; sensation as if a drop were running through the urethra; 
nightly painful erection ; impotence after gonorrhoea. 

Worse in the evening, and at night ; also in cold, wet weather, 
and from the heat of the bed. 

Better in warm, wet weather. 

Veratrum album. Suppressed urinary secretion ; continuous 
urging to urinate; involuntary flow of urine; dark-red urine, dis- 
charged frequently, but in small quantities ; green urine ; frequent 
micturition, with violent thirst and hunger, headache, nausea, colic, 
constipation, and coryza. 



232 Surgical Diseases of the Bladder. 

Worse in the morning ; also after sleep, and when he is wrapped 
up warmly. 

Better after perspiring. 

ZitlCUm met. Pressing, stinging and soreness in the kidneys ; 
violent pressure of urine in the bladder ; retention of urine when 
beginning to urinate ; can only pass urine (which she must do 
every hour) in a sitting posture ; excessive desire to urinate at night ; 
urine is turbid, in the morning loam-colored ; frequent micturition 
of pale-yellow urine, which later deposits a white, flaky sediment ; 
discharge of blood from the urethra after painful urination ; burn- 
ing during and after micturition ; cutting pain in the orifice of the 
urethra; involuntary discharge of urine when walking, coughing 
and sneezing ; stones in the kidneys and bladder ; great falling oft 
of the hair on the genitals ; nymphomania, with great sensitiveness 
of the genitals ; violent long-lasting erections. 

Worse in the afternoon and evening ; also from wine, and in the 
warm room. 

Better in the open air. 

There are one or two additional remedies, and, as they are of 
importance, I do not know how I came to omit them. They are ; 
Agnus cast., Amnion, ntur., Argent nit., Merc, cor., Mezer., Rhus 
rad., and Sepia. 

AgnilS castUS. Yellow purulent discharge from the urethra, 
after the inflammatory symptoms of gonorrhoea have subsided; 
gonorrhoea with suppressed sexual desire ; itching of the genitals. 

Ammonia mur. Diminished secretion of urine ; slow flow of 
urine, more abundant during stool; frequent urination, especially 
towards morning; sediment like clay. 

Worse in the morning and afternoon. 

Better in the open air. 

Argentum nit. Frequent and copious emission of pale urine ; 
inflammation, and violent burning or shooting pains in the urethra, 
with increased gonorrhoea; priapism' with bleeding from the 
urethra ; sexual desire wanting, the genitals become shriveled. 

MercurillS COr. Tenesmus of the bladder, suppressed urine; 
increased discharge of urine ; the urine is only passed in drops, 
and in great pain ; urine scanty, brown, with brick-dust sediment ; 
itching in the forepart of the urethra; gonorrhoea, first thin, then 
thicker, then smarting pain when urinating, with stitches in the 



Special Therapeutics, 233 

urethra ; burning in the urethra, more before micturition ; violent 
erections during sleep. 

Worse in the evening, and at night ; also from cold ? 

Mezereum. Diminished secretion of urine; in the morning 
and forenoon, frequent discharge of large quantities of pale urine ; 
the urine becomes flaky, and has a red sediment ; hematuria ; 
sticking in the kidney, and pain as if torn ; after micturition, itch- 
ing at the prepuce; discharge of mucus from the urethra; heat 
and swelling of the penis ; violent erections, and increased sexual 
desire. 

Worse in the evening, and at night ; also from being touched, 
and from motion. 

Better when walking in the open air. 

Rhus rad. Symptoms are almost identical with those of Rhus 
tox.; when thecase and the remedy agree, but the tox. produces no 
effect, I have often succeeded with this remedy in effecting a 
cure. 

Sepia. Frequent urging to urinate, from pressure on the blad- 
der ; frequent micturition, even at night has to rise often ; burning 
in the bladder, and in the orifice of the urethra ; smarting in the 
urethra when urinating ; urine turbid, with sediment of red sand ; 
blood-red, with white sediment, and a cuticle on the surface ; very 
offensive, with much white sediment ; continued erections at night ; 
violent upward stitches in the vagina; redness, swelling, humid 
itching eruption on the labise. 

Worse in the forenoon, and in the evening; also from washing 
in water, and on bending down. 

Better from warm air, and violent exercise. 



Operations. 

Perineal abscess. — When practicable they should be opened by 
an oblique incision, by entering the knife through the skin at a 
distance from the abscess. 

Organic Urethral Stricture. — It often happens that remedies 
fail to reach these cases. When such is the case, a catheter (made 
for the purpose), with a knife-blade concealed, can be intro- 
duced as far as the stricture, and then made, by the action of a 
spring, to sever it. Other methods are often used, such as gradual 



234 Surgical Diseases of the Bladder, 

dilatation by means of graduated bougies, one of which is some- 
times used constantly. 

Calculi. — These serious diseases are remediable by operative 
procedure, in two manners. The cutting operation, and the 
crushing. The first is called lithotomy, and the last lithotripsy. Of 
the first we have a choice of three methods: ist. The median; 
2d. the high : 3d. the lateral operation. The last is the one most 
used in this country. In this, an instrument shaped like a catheter, 
but having a deep groove along the curved border, called a " staff," 
is introduced into the bladder, and held by an assistant. The 
surgeon makes the incision from the raphe of the perineum, 
obliquely downwards, as far as the upper margin of the anus, 
though terminating at the distance of an inch and a half or two 
inches from it. This incision may be three inches long. When it 
is deep enough to reach the staff, the point of the knife is engaged 
in the groove of that instrument, and pushed into the bladder. 
The finger being inserted into the opening thus made, a pair of 
forceps made for the purpose, are then passed in, and the stone 
brought away. The staff must not be withdrawn until the operator 
has his finger in the bladder. Previous to commencing, the blad- 
der is to be injected with tepid water, and this allowed to run out 
when the stone is removed. The bladder is then to be washed 
out, and the wound left open to heal from the bottom. Pass a 
gum-elastic catheter into the bladder through the wound, and leave 
it there until the urine begins to come from the urethra. 

When operating by the crushing method, care must be taken 
above all things to have a perfectly good instrument, as if one of 
the jaws should break off in the bladder, the case will be very much 
complicated. The instrument used, is about the diameter of a 
large catheter, and is made to open and close two powerful con- 
cealed jaws by means of a screw in the handle. The size of the 
stone is acurately told by a scale cut into the handle of the instru- 
ment. When the stone has become engaged in the jaws of the 
lithotripe, it must be crushed slowly; the bladder injected with 
tepid water, and the utmost care exercised to ensure the expulsion 
of every particle of stone. The smallest piece remaining may 
(and nearly always will) serve as the nucleus for a new formation. 

These operations are both of them very serious ones, and it 
must only be after the most careful and persevering use of reme- 
dies, that either of them are resorted to. The mortality under 



Orchitis. 235 

old school treatment is fearful,and we have every reason, judging 
from our past experience, to believe that the time will come 
when it will never be necessary to cut for stone. But let it be 
borne in mind, that inasmuch as a stone in the bladder is the 
hardest thing in the world to diagnose, it behooves us to be very 
cautious, at least, when we assert that we have cured them. 



DISEASES OF THE SCROTUM AND 

TESTICLES. 



ORCHITIS — HYDROCELE — VARICOCELE — HEMAT- 
OCELE. 

Orchitis is spoken of, as " blenorrhagic epididymitis," from the 
fact that in gonorrhoea or blenorrhcea, the epididymus is often 
affected; hernia humoralis and swelled testicles, are among the 
common names. Gonorrhoea suddenly suppressed by quack 
medicines, cold, or injudicious treatment frequently causes it. 
But cold, without the existence of gonorrhoea, a bruise, straining 
from heavy lifting and the like, often produces it. When a cure 
is effected there may be a hard, button-like swelling at the lower 
end of the affected testicle, that will remain. 

The symptoms are, swelling and hardness of the whole, or only 
one side of the scrotum ; red, painful and hot ; sometimes the 
surface is covered with small blisters, which burst, dry up into 
small scales and fall off; the least touch, even the weight of a 
single sheet, or the slightest motion, laughing or talking, will 
generally greatly increase the sufferings ; the pain is of a dragging 
character, and usually extends up along the spermatic cord of that 
side. The patient usually is found lying on the back, with the 
head high, knees drawn up and widely separated. The so-called 
"constitutional" symptoms are, fever, thirst, restlessness, often 
headache, urinary difficulties, and generally constipation, some- 
times diarrhoea ; at other times the bowels are not at all affected. 



236 Surgical Diseases — Scrotum and Testicles, 

Hydrocele. 

Hydrocele is an effusion of fluid, either into the scrotum, or 
the coverings of either the testicles, or the spermatic cord. When 
in the cellular tissue, it is " external hydrocele ; " the opposite 
condition is " internal," and is divided into several other varieties. 
When it is contained in the envelope of the testicle, it is called 
"hydrocele of the tunica vaginalis;" and if communication 
between the abdomen and the interior of the sac is unobstructed, 
it is called " congenital." When the membranes of the spermatic 
cord are the seat of the disease, we speak of two varieties, the 
"encysted," and "diffused." In shape, the tumor thus formed is 
oblong, larger below than above, and, when examined in a dark 
room by transmitted light, the testicle can be clearly seen at the 
back of the scrotum. The operation of tapping may have to be 
resorted to, but as it is merely palliation, often aggravating, it 
should be seldom performed. 

Orchitis, according to Velpeau frequently causes this disease. 
It is usually found in a chronic form. Pain or inflammation rarely 
exists though some tenderness of the testicles may be met with. 
In old cases, in which some (or many), structural changes have 
taken place, many of the most essential symptoms to founding a 
correct diagnosis are wanting, and as light cannot be trans- 
mitted, the nature of the disease is sometimes very obscure. 
We may confo nd the disease with hoematocele, or any enlarge- 
ment of the scrotum. An exploring needle will generally settle 
the matter. The fluid is usually of a light straw-color, but when 
the case is of long standing, by the disintegration of the blood 
globules, the fluid will be of a dark-turbid appearance, and may 
incline one to think it is hoematocele. This, joined to the 
thickening of the walls, will obscure the diagnosis very much. 
The fluid may accumulate in any quantity; sufficient to distend 
the scrotum from the size of an egg, to that of a large cocoanut. 
The swelling is also, not always even and oblong, sometimes 
assuming an hour-glass form, and again looks like a multilo- 
cular cyst. 

Varicocele. 

Varicocele is simply a varixed condition of the veins of the 
scrotum and spermatic cord, and has been confounded with scrotal 



tfcematocele. 237 

hernia. The veins of both the scrotum and the cord may be 
affected, or of only one of them ; those of the cord are generally 
found to be the ones involved. It is a soft, doughy, compressi- 
ble tumor, having a knotted, unequal surface, situated in the 
course of the spermatic cord, and increasing in size from below 
upwards. After lying down the tumor diminishes in bulk, and on 
standing up or walking increases in size again. In the scrotal 
variety the size seems to be greatest at the bottom, while all the 
other signs (except that following the course of the cord), are the 
the same. When both cord and scrotum are involved, the size is 
nearly uniform, top and bottom. The disease is easily diagnosed, 
and requires the simplest treatment. Debility of the genital 
organs, and frequent seminal emissions accompany varicocele 
quite frequently, from the fact that the disease is often referable 
to venereal excesses. One fact must be borne in mind : When 
the left spermatic veins are varicosed, and constipation accom- 
panies it, or is the natural condition of the patient, the cause of 
the varix is, in many cases, pressure exerted by fecal matter, 
accumulated in the sigmoid flexure of the colon, on the veins ; one 
of the first indications in such cases, is to remove this mechanical 
obstruction to the flow of the blood. 

HEMATOCELE. 

Hematocele is a simple effusion of blood (from an injury, gen- 
erally) into one of the tunics of the scrotum, and, of course, apart 
from the character of the fluid, it presents many of the charac- 
teristics of hydrocele. Many suppose it to be an effusion of blood 
into the cellular texture of the scrotum ; others, an effusion into 
the tunica vaginalis ; still others, into the tunica albuginea itself. 
The first is the common belief, but I incline to the second, viz., 
that it differs from hydrocele only in the character of the effusion, 
as regards seat or external appearances. Although the disease is 
usually produced by an injury, yet it has often occurred sponta- 
neously. When tapping for hydrocele, it has sometimes resulted 
from the point of the trocar wounding one of the vessels of the 
scrotum. 

Trifling as it may appear in its immediate and remote effects, it 
is many times a very formidable accident, and requires very 
prompt treatment. If our remedies are acting slowly, or do not 



238 Surgical Diseases — Scrotum and Testicles. 

act at all, do not waste time, but operate at once. Of the two 
varieties, the traumatic and spontaneous, the last is the rar^t and 
much the most formidable. From some cause or another, perhaps 
varix, one of the spermatic veins becomes enlarged, bursts, and 
pours out blood in quantities, the scrotum usually w staining a 
greater size than when it has a traumatic origin. 

Rather than have the effused blood become disorga lized, with 
all its attendant evils, I would give but two weeks of medicinal 
treatment, and if nothing resulted, operate. But should good, ever 
so little, result, keep on with the medicines. It has sometimes 
occurred that the blood has coagulated. When the cl;t is found 
to be firm, he is criminal who does not remove it by operation. 

Care must be taken that we do not confound haematocele with 
hernia, or chronic hydrocele. Many of the symptoms and signs 
are similar to hernia, and haematocele of the spermatic cord, as it 
is apt to result from a strain, the similarity is very striking; but 
as Erichsen says, "the more diffuse character of the swelling, its 
irregular feel, and semi-fluctuating sensation, might enable the 
diagnosis to be made." Haematocele of the cord, can be readily 
distinguished from that of the tunica vaginalis ; in the former the 
testicle is not implicated, while in the latter it is felt surrounded 
by the fluid. 

Treatment. — Among the allopaths there is a custom, which 
many of our own faith are adopting, of strapping the scrotum with 
strips of adhesive plaster in cases of orchitis, which is very hurtful 
and useless. Trust to remedies and some simple appliances. It 
is of prime importance to keep the patient quiet in bed, room not 
too hot, covered lightly with bed clothes, with a bent hoop to keep 
their weight off; if the scrotum is greatly enlarged, a light suspen- 
sory bandage may be used, but it must exercise no constriction ; 
use no washes, or any topical application, and let the diet be light, 
forbidding coffee or any spiritous liquors. 

In the case of Hydrocele, the strapping process is very useful if 
too much compression is not exercised; that is, not enough to 
endanger the testes ; it is preferable to bandaging, as the latter 
can only with difficulty be kept smoothly applied. When the 
tumor is large, painful, and the remedies act but slowly, not pre- 
senting a constant accumulation of fluid, tapping may be resorted 
to as a temporary expedient, never with any hopes of effecting a 
cure by such means. 



Special Therapeutics. 239 

Hczrnatocde should never be compressed by bandages or straps. 
If the cause is a rupture of some large vessel, that vessel has to 
be obliterated; if pressure will not check the hemorrhage, it must 
be exposed, and ligated. 

Varicocele, as it is an important subject, I shall speak of a little 
more in extenso. When called to see a case of this kind, first 
discover the cause, and then direct your treatment to the removal 
of that cause first ; thus, if an accumulation of feces is the direct 
cause, have that removed by injections, or other mechanical 
means. One of the first indications is to afford artificial support 
to the over-distended veins by judicious bandaging, which will be 
found in nearly all cases quite indispensable. The only topical 
treatment I would advise, is the watery extract of Hamamelis 
virg., and then only at such times as the same remedy is being 
administered internally. It is not good homoeopathy, indeed to 
my mind is not homoeopathy at all, to use one remedy internally, 
and a different one topically; it is nothing but alternation, and 
that we know is heresy. 

The remedies may be arranged as follows : 
Orchitis: Aeon., Aur. met., Nux vom. ; Ars., Clem., Lye, Merc, 
Nit. ac, Spong., Staph., Zinc. 

from Strains or Bruises. — Am., Con., Ruta, Puis. 

from Suppressed Gonorrhoea. — Puis. ; Aur., Clem., Merc, 

Nit. cue. 

from Metastasis of Mumps. — Merc, Nux v., Puis. 



Hydrocele: Am., Ars., Chin., Con., Dig., Graph., Hell., Hepar 

s., Merc, Nux v., Puis., Sil., Sulph. 
Varicocele: Hama. virg. ; Aeon., Am., Ars., Carbo v., Graph., 

Lach., Lye, Nux v., Puis., Sep., Sulph. 
Hematocele : Am., Con., Ruta, Sulph. j Erigeron. 

Aconite nap. Fever of an inflammatory character, with red 
cheeks, headache restlessness and followed by a profuse perspir- 
ation; dry, burning fever at night, with thirst, and delirium; 
fever ushered in by coldness and shivering ; fear and apprehen- 
sion of death; diarrhoea, with nausea and sweat; retention, or else 
difficult and scanty emission of urine, with painful urging; inflam- 
mation and itching of the scrotum; pain in the scrotum as if 
contused; tingling of the genitals; after a walk, (in cases of 
varicocele), the scrotum is painful, and the veins are much dis- 
tended ; inflammation of the scrotum, and inolterable pain along 



240 Surgical Diseases — Scrotum and Testicles. 

the course of the cord ; stinging pains ; the scrotum, being inflamed, 
feels burning to the patient, and dry and hot to the hand; loss of 
appetite, amounting often to aversion of food ; loose stools, with 
much straining; pain in the rectum; numbness and lameness of 
the left thigh. 

Worse in the evening, and at night ; also when lying on the left 
side, in a warm room, and when rising from the seat or bed. 

Better in the open air. Right side. 

Arnica mon. Orchitis arising from a bruise or contusion; a 
sense of dull pain, or aching, in the testicle ; the fever comes on 
in the morning, is of a dry, burning character, no thirst with the 
fever; yawning before the fever, accompanied by a great deal of 
thirst ; frequent small and slimy stools, or stools consisting solely 
of slime ; tenesmus of the neck of the bladder ; stitches in the 
urethra; brown urine, with brick- red sediment; small quantities 
of yellow-red urine ; red-blue swelling of the scrotum, and inflam- 
matory swelling of the testicles ; painful swelling of the spermatic 
cord, with lancinations from the testicles into the abdomen; 
varicocele without pain, a dull tingling sensation, or an uneasy 

feeling in the swelling. 

Worse in the morning, evening, and at night ; also from moving, 

and on being touched. 

Better when lying down. Right side. 

Arsenicum alb. The pains are felt at night when sleeping, and do 
not wake the patient up ; dry, burning fever; the patient complains 
of feeling cold, but to the hand the surface is warm ; thirst during 
the fever, but only drinks a mouthful at a time ; dry, burning inter- 
nal heat ; emaciation and weakness ; diarrhoea of a putrid smell, 
profuse and watery; retention, or involuntary emission of urine! 
burning in tne urethra; swelling of the scrotum, with heat, red- 
ness, or a red-blue color; pain very severe; varicocele in persons 
who have had their health broken with Quinine ; veins enormously 
distended, of a deep blue color extending to the whole scrotum ; 
burning steady pain in the scrotum ; loss of appetite. 

Worse at night; also from cold, when lying on the affected side, 
and when the head is low. 

Better from heat, or warm applications, and when lying with the 
head high. Either side. 

Alinim fol. Orchitis produced by the abuse of Mercury " regu* 
larly ;" very sensitive to cold and drafts; thinks constantly of 



Special Therapeutics. 241 

suicide, and has thoughts of attempting it; quarrelsome and 
peevish; turbid urine; yellow, thick, white urine almost like gon- 
orrhceal discharge; dull cutting, and lancinations in the urethra 
diarrhoea, or constipation, with burning in the rectum ; the external 
border of the rectum is swollen and painful ; nightly erections and 
pollutions, with itching of the scrotum; on touching or rubbing 
the testicle, aching pain. I have cured so many cases of orchitis 
with this remedy, that I almost began to think it a specific. The 
symptoms I have oftenest met that were cured by its use, are as 
follows : Tense, smooth, shining swelling of the scrotum, more on 
the left side ; dragging pain in the scrotum and along the sper- 
matic cord ; pain on the slightest motion, on straightening out the 
leg of that side, when turning in bed, from talking or laughing; 
small scales on the lower point of the scrotum on the left side, 
coming off entire ; scanty emission of hot urine ; little thirst, no 
appetite; fever, restlessness and sleeplessness at night. 

Worse in the morning; also from cold. 

Better from warmth. Right side, (Bcenninghausen). Left side 
(Gilchrist). 

Clematis erecta. Swelling and induration of both testicles, or 
of only the right ; pain as if bruised on touching the testes ; 
drawing pain in the testes and spermatic cord, from below upwards ; 
painful sensitiveness of the testes; swelling of the scrotum; loose 
stool; hemorrhoids; fever at night; dry heat; chilliness on being 
uncovered. 

Worse at night ? also from the heat of the bed, and from washing. 

Better from pressure ? Right side. 

CarbO Veg. Loss of appetite; constipation, with hard stool 
every two or three days ; discharge of blood with the stool ; sore- 
ness of the perineum ; swelling of the scrotum, which is also hard 
to the touch ; pressing in the testicles. 

Worse in the morning, and forenoon; also from cold air, and 
before the fever. 

Better after lying down. 

China Off. Drawing in the testicles; swelling of the spermatic 
cord; urine dark, turbid and scanty. 

Worse at night ; also from touching the parts if ever so softly. 

Better from warmth, in general. Generally the left side, though 
it may be either. 

Conium mac. Pains, of a very severe character, come on at 
16 









242 Surgical Diseases — Scrotum and Testicles. 

night while the patient is sleeping and waken him ; restlessness 
and constant desire to change the position; orchitis from a con- 
tusion ; swelling of the testes. 

Worse at night ; also when standing, or when at rest. 

Better from moving and walking. Right side. 

Digitalis pur. Great distension of the scrotum, until the skin 
looks as thin as a bladder; dropsical swelling of the genitals; 
contusive pain in the right testicle; fever, with internal chilliness, 
and external heat. Feels rather better in the forenoon, though 
there is but little change all day. 

Erigeron can. One of Hale's " new remedies," and the char- 
acteristic symptoms are unreliable. It is used empirically a great 
deal for hemorrhages of all kinds (except arterial), and has proved 
very valuable. Useful in hematocele in the first stages. 

Graphites. Feeling of great tension in the parts ; constipation, 
with burning in the rectum ; white mucus mixed with the stool ; 
the prepuce is dropsical. 

Worse at night; also from cold. 

Better from pressure ? Either side. 

Hamamelis Virg. The list of symptoms of this most important 
remedy are very meagre. I have used it very much, and have 
been obliged to do so in an empirical way, but have found it the 
very best remedy I have used in the treatment of varicocele. I 
have never used higher than the twelfth. The external use of 
the fluid extract is the common method of administration. 

HelleborilS nig. Hydrocele after suppressed eruptions; sup- 
pression of the sexual desire. 

Worse in the evening; also in the cold, and from bodily exertion. 

Better in the warm air. He feels better in the open air, but 
feels as if he had been sick for a long time. Either side. 

Hepar SUlphuris. Long-standing hydrocele; large swelling of 
the scrotum, containing fluid which is dark and thick; throbbing 
in the scrotum ; humid soreness on the genitals, and on the thighs 
between them and the scrotum ; discharge of prostatic fluid during 
urination, or when passing the hard stool. 

Worse at night ; also from the cold air, when lying on the painful 
side, from pressure, and when touching the parts. 

Better from warmth. Right side ? 

Lycopodium. Fever in the evening; burning heat, with short 
breath, pale face, and starting from the sleep ; ineffectual urging 



Special Therapeutics. 243 

to stool; contractive pain in the perineum; violent, but short, 
drawing pain in the forepart of the urethra; chronic orchitis; pain 
in the perineum when sitting; passage of blood from the rectum; 
soreness between the scrotum and the thighs ; dropsical swelling 
of the genital organs. 

Worse in the afternoon and evening; also from lying down, 
when sitting, from the pressure of the clothes, and while urinating. 

Better from cold. Right side. 

MerClirillS. Violent thirst; continual coldness of the hands 
and feet ; great fever at night ; profuse perspiration which affords 
no relief; sweat with nausea and languor; desire for stool every 
minute, with tenesmus but no passages; diarrhcea; flow of milky- 
urine ; red, brown or turbid urine ; sour smelling urine ; bloody 
urine; discharge of pure blood from the urethra; drawing, with 
pressure in the testicles ; drawing pain in the testicles and in the 
groin; drawing in the spermatic cord; shining redness of the 
scrotum ; swelling of the scrotum ; pain intolerable. 

Worse at night, and from the heat of the bed. 

Better from cold, and while sitting. Right side. 

Nitric acid. Orchitis from abuse of Mercury; cold skin over 
the whole body; chilliness, especially in the evening; night- 
sweats, sometimes every night, at other times every other night ; 
foetid perspiration ; constipation, or diarrhoea ; discharge of blood 
from the rectum during stool ; painful suppression of urine ; draw- 
ing pain in the testicles ; testicles painful when touched ; violent 
itching of the scrotum ; lacerating in the spermatic cord ; painful 
when touched. 

Worse in the evening, and at night; also on touching the parts, 
and on rising from the seat. 

Better on getting warm. Left side. 

NlIX vomica. Chilliness, with heat of the head; fever in the 
afternoon or evening; burning sensation, or one of internal heat 
through the body ; morning sweats ; constipation, with ineffectual 
urging to stool ; painful spasmodic stricture of the anus ; painful 
and ineffectual desire to urinate , burning or itching in the urethra ; 
lacerating or burning in the neck of the bladder ; itching of the 
scrotum ; heat in the testicles ; inflammation of both testicles, with 
swelling, hardness, and drawing of them up; sticking and spas- 
modic choking sensation, rising into the spermatic cord. 

Worse in the morning; also from motion, and slight touch. 



244 Surgical Diseases — Scrotum and Testicles. 

Better irom strong pressure. Right side. 

Pulsatilla. Coldness; shuddering; feeling of chilliness, with 
trembling; fever comes on in the afternoon or evening; dry heat 
of the body at night ; morning sweat ; diarrhoea stools, mixed with 
mucus ; stools consisting of nothing but mucus mixed with blood ; 
retention or incontinence of urine ; colorless, watery urine ; swell- 
ing of the scrotum; lacerating pain in the testes; drawing and 
drawing-tension from the abdomen through the spermatic cord to 
the testicles; inflammation and swelling of the testicles, with 
swelling of the scrotum after suppressed gonorrhoea; burning in 
testicles without swelling. 

Worse in the evening, and the forepart of the night ; also when 
lying on the painless side, while moving, and from warmth. 

Better in the open air, and from cold. Right side. 

Ruta graveolens. Have used it for varicocele following a 
severe strain. 

Silicea. Continuous urging to urinate, with scanty discharge ; 
itching, humid spots on the scrotum ; discharge of prostatic fluid 
when urinating and during stool ; increased sexual desire ; hydro- 
cele. 

Worse in the night ; also in the open air, from cold, from getting 
wet, and from pressure. 

Better from warmth. Either side. 

Sulphur. Retention of urine ; or frequent micturition, only of 
drops ; hemorrhage from the urethra ; discharge of prostatic fluid 
after micturition; the testicles hang down loosely; offensive 
perspiration around the genitals; soreness and moisture of the 
scrotum ; soreness between the scrotum and the thighs. 

Worse in the evening, and at night ; also on getting warm in 
bed, from talking, on standing, from touching the parts, and from 
water and washing. 

Better during motion, and from heat. Right side. 

Operations. 

Varicocele is to be cured (when by operation) by the obliteration 
of the veins. This may be done either by ligation, or pressure 
exerted on the vein directly. When the former plan is pursued, 
use the same procedures and precautions as in the case of 
arteries. When the latter, the best plan is to insert hair-lip pins 



Diseases of the Uterus, 245 

under the veins, and twist silk or wire around them in a figure-of- 
eight manner. 

Hydrocele is often tapped, either under the mistaken belief that 
such a procedure will cure it, or as a palliative measure. It does 
not cure any more than amputation cures gangrene; it only 
destroys the parts. The trocar and canula should be small, and 
care must be taken not to wound the testicle. 

These operations are but seldom called for in our practice, and 
the time will soon be here when they will never be performed ; of 
this I am confident 



SURGICAL DISEASES OF THE FEMALE 

GENITALIA. 



DISEASES OF THE UTERUS — OVARIAN TUMORS — 
VAGINAL FISTULA. 

Diseases or the Uterus are many, but a great majority of 
them are more strictly obstetrical, and need not to be mentioned 
in a work of this character. The diseases we shall speak of are 
as follows: (a) Hydrometra; (0) physometra; (c) foreign bodies 
in uterus ; (d) cancer of the uterus ; (e) ulceration ; (/) gangrene. 

(a J. Hydrometra. — Dropsy of the uterus never sets in until the 
catamenia are regularly established, or seldom after their final 
cessation. The causes are various : a blow, miscarriage, suppres- 
sion by some means of the lochia, leucorrhcea, menstruation, etc. 
Often the cause depends upon, or exists in connection with, some 
disease of the womb. Among these may be classed, scirrhous, 
hydatids, or tubercular disease. It may readily be confounded 
with pregnancy. We hear three varieties spoken of: the uterine, 
hydatids, and the dropsy common to pregnant women. 1st. Ascites. 
This is a simple accumulation of fluid in the cavity of the uterus. 
Jahr speaks of it as being either "persistent or periodical." The 
symptoms in the former case are as follows : suppression of the 
menses, with pain in the back and abdomen, swelling of the abdo- 
men, and, in those cases which simulate pregnancy, swelling of the 



246 .Surgical Diseases of the Female Genitals. 

breasts with discharge from them of a milky substance. Months 
or years may elapse, the abdomen swelling steadily, and at last a 
fall, blow, or some other cause, will result in an expulsion of the 
fluid by a process closely resembling labor. The patient com- 
plains of uterine pains, the mouth of the uterus dilates, and the 
fluid is expelled. The point of difference, then, between the two 
varieties, " peristent " and " periodical " is, that in the former a 
cure follows, the fluid is not re-secreted; whilst in the latter, it 
again accumulates. 

2d. Hydatids. — In appearance resemble cysts; multilocular 
generally, and give rise to very nearly the same symptoms as 
ascites. They are expelled as in confinement, the expulsion being 
followed by hemorrhage and weakness. In appearance the only 
difTerence from ascites is, that the former is not enclosed in a 
separate investment. 

3d. The dropsy seen in pregnant women has no connection 
with our subject. I consider it to be merely an excess of the 
amniotic fluid. 

(b). Physometra. — Sometimes this is called " tympanitis " of the 
uterus. It is simply an accumulation of gas in the cavity of this 
organ. The most common cause is, probably, the decomposition 
of coagula, or from some portions of the placenta, or from a dead 
foetus. It may be generated by the walls of the uterus. 

(c). Foreign bodies in the uterus. — They are moles, hydatids, 
calculi, and the like. Moles are a shapeless, fleshy mass, the result 
of imperfect conception. Hydatids when existing in large num- 
bers, are frequently spoken of as moles. Concretions. — "These 
are the sanguineous and lymphatic concretions formed in the womb. 
The sanguineous concretions are a species of coagula, which might 
be compared to the polypus concretions in the heart and larger 
vessels, although the coagula in the womb are more consistent, and 
show more signs of organization ; often they are surrounded by a 
fibrinous layer of a grayish-whitish color which envelope them like 
a membrane, and increase this organized appearance ; but in 
dissecting them carefully, this appearance disappears, and no 
cavity with smooth walls is found in their interior, as is the case 
with fleshy moles. * * * * The formation of these coagula 
takes place most frequently in women who menstruate copiously, 
and whose lochia do not flow regularly ; even young unmarried 
females are attacked by such disorders. When such concretions 



Diseases of r the Uterus, 247 

take place, the menses cease." — Jahr. The expulsion of these 
bodies resembles the natural process of labor closely, and may be 
speedy or gradual ; when the latter the hemorrhage is very severe. 

" Lymphatic concretions," says Jahr, " are membraneous bodies 
of integumentous consistence, and of a dirty-white color resem- 
bling the membranes in croup. They are formed in the uterine 
cavity, and are afterwards expelled, either shaped as a sac or as a 
bursa, the external surface of which is studded with filaments, 
and the internal is smooth and moistened with a serous liquid." 
These formations are sometimes simple patches, at others a com- 
plete cast of the womb. They are rarely reproduced after being 
expelled. 

Uterine polyps differ in no material degree from the same bodies 
elsewhere. 

Calculi or Fibrous bodies in uterus, are tumors, frequently of the 
polyp shape , and may be of almost any texture, from a simple 
sarcoma, to almost hard bone. When sarcomatous, I should call 
them polyp. They may be of any size, from that of a pea to a 
fist, or as in one case, large enough to weigh thirty pounds. 
Unmarried women are more subject to them than the married, and 
also those who have been childless, than those who have had sev- 
eral children. In fact among the married, the immunity increases 
in proportion to the number Of children borne. Jahr and others 
consider the different textures of which they have been found to be 
composed, to be indicative of their age. Thus bone or calcareous 
matter is the natural composition, and the sarcomatous and fibrous 
forms, are but steps to the complete formation. 

(d). Cancer of the Uterus. — The same remarks apply to this 
disease as to polypi : a cancer is the same everywhere. Most of 
the older authors, in the language of Jahr, considers cancer of 
the uterus to be " every affection, which at the same time as it 
changes the tissues of the uterus, naturally tends to spread all 
around, and to destroy itself by ulceration in the centre." 

(e). Ulceration of the Uterus. — Ulcers of this organ are quite 
common, and may be classified the same as the cuticular varieties. 
They may be classified in this place in reference to the cause, 
complications and appearance, as follows : Superficial erosions, 
deep-seated ulcers, herpetic ulcers, scorbutic, scrofulous, syphilitic 
and cancerous. See " Ulcers." 

(f). Gangrene of the Uterus. — This is a terrible accident, and 



248 Surgical Diseases of the Female Genitals. 

one that promises but little hope for the sufferer. Acute metritis, 
or any intense inflammation may culminate thus. The mortality is 
partially due to the fact, of the almost utter impossibility ot 
diagnosing the condition, until after death. When the case is 
serious the diagnosis may be made out from the symptoms, pains 
in the hypogastrium which had existed until then, disappear ; a 
brownish liquid of a fetid odor, is discharged from the vulva; a 
diarrhoea of a cadaverous smell, sets in, and a cold and clammy 
sweat breaks out, either over the whole body, or only on some parts ; 
the pulse becomes frequent, small and intermittent ; the features 
are deeply altered, the extremities become colder, and the patient 
sinks into syncope, or a prolonged coma, with or without 
delirium. 

Ovarian Tumors. 

Ovarian Tumors are more commonly met after the climacteric 
period, though they may exist at any age after puberty. I believe 
they are never seen, or if so very rarely, before the catamenia are 
established. They may be cystic, or solid in form, though it is a 
question with many, if the solid" form be not an advanced stage of 
the cystic. Like all cysts, they may be single or multiple; 
some of the older writers speak of the " binocular," but we now 
call them all multilocular when there is more than one cyst on the 
pedicle. The contents of these cysts may be thick and albumin- 
ous, or thin and watery, and the same variety is found in the 
color ; the fluid may be colorless like water, or brown, or even 
black. In consistency then, it may be anything between a fluid 
and a semi-solid, and in color, from watery to black. Not un- 
frequently, we find the contents to be made up of hair, portions of 
bone, and in one case a complete lower jaw furnished with a full 
set of teeth. These are evidently the remains of a blighted ovum, 
or may be the result of ovular impregnation. The causes that 
may operate to produce these formations are many, though some 
direct violence is the most common. They are never cured 
spontaneously, always progressing more or less slowly to a fatal 
termination, unless arrested or removed. They may be of almost 
any size. 

Vaginal Fistula. 

Vaginal Fistula. There are several varieties of fistula, 
which we will briefly notice, premising the remark, that in spite of 



Vaginal Fistula. 249 

what many oi us have been taught, they are all more or less 
curable by internal treatment, save one variety, the first we shall 
notice. 

(a). Enter 0- Vaginal Fistula. — This affection is so rare, that 
I will simply quote Erichsen : " It is a communication set up 
between the small intestine and the vagina, an artificial anus in 
fact. These cases, may indeed be looked upon as incurable ; for 
though some of the French surgeons, as Roux and Cassamayor, 
have endeavored to establish by a deep and difficult dissection a 
communication between the small and large intestine, the opera- 
tion, as might have been expected, has proved fatal to the 
patient." The only thing to be done apparently, is to let it alone. 
What if the fistula should be closed ? as there is no other outlet 
for the feces, an artificial anus would have to be made somewhere 
else, and might prove as fatal as the French attempts. I 
believe this condition is nearly always congenital. 

(b). Recto- Vaginal Fistula. — Is a very disgusting complaint, 
and one that is common at all times of life. The causes are various. 
One of the most common is, the long impaction during labor of 
the head of the child in the vagina, and consequent upon the 
contusion, inflammation, gangrene, terminating in sloughing. Cases 
have occurred from perineal laceration extending into the vagina, 
partially healed, when an adhesion was set up between this canal 
and the rectum, followed by inflammation, ulceration and 
sloughing. 

(c). Urinary- Vaginal Fistula, may also be due to the long im- 
paction of the child's head during labor, and like the other variety 
may be caused by direct personal violence. A kick, by produc- 
ing congestion and ultimate sloughing, or by lacerating the parts 
is, among a certain class, often the cause. The urethral 
opening from that canal into the vagina, is by far the most 
common, as the point of resistance furnished by the pubic bone, 
renders this passage more obnoxious to injurious pressure. When 
the opening is through the bladder itself, it is spoken of as vesico- 
vaginal, which is larger, more ragged and more difficult to treat 
than the other. This is usually the result of abscess or some 
disease, as their position precludes the possibility of compression 
during labor being exercised to that extent, and they are too far 
back to be the result of an injury, unless it be one produced by 
attempting abortion. 



250 Surgical Diseases of the Female Genitals. 

Treatment. — In the cure of physotnetra, it is well to see to it 
that the expulsion of the gas is complete and the mechanical 
cause removed. In the case of foreign bodies in the uterus, they 
must be expelled, not absorbed. In cancer, and the same remarks 
apply to ulceration, no caustics, or any kind of local treatment 
must be allowed, farther than is necessary to complete cleanliness ; 
trust to remedies. 

In the treatment of " ovarian tumors" paracentesis, or tapping, 
is not good surgery, neither is it good Homoeopathy ; at the first it is 
merely palliative and commonly it produces aggravation. It 
the remedies do not act well, or all other measures fail to relieve, 
I should operate at once. Unrelieved the patient will surely die, 
and an operation promises much. 

In cases of " vaginal fistula" of all kinds, I am much inclined to 
think that local treatment will be found that which promises best ; 
but of course this depends upon the cause; if from a blow, 
treat it as ordinary contusions. In the case of all fistulse, save the 
entero and vesico-vaginal, an operation seems to be the safest, best, 
and most speedy way of effecting a cure. In urinary fistulae, one 
main indication is to prevent the urine from entering the vagina ; 
for this purpose wear a catheter constantly, or until the opening 
is closed. In all these fistulse the examination must be thorough, 
both digital and ocular, by means of a speculum. 

The remedies we find most useful may be arranged as follows : 
Hydrometra : Ars., Bell., Chin., Hell., Merc, Sulph., Bry., Calc, 
Con., Ferr., Jod., Kali, Lach., Lye, Puis., Ruta., Sabin., 
Sepia. 

after miscarriage. — Bell., Sabin., Secale, Sep., Bry., Calc, 

Chin., Fer., Kali, Puis., Sulph. 

after blows on the Hypogastrium. — A?-n., Con., Puis., 

Rhus, Bry., Jod., Lach., Phos., Ruta., Sulph. 

with Hydatids. — Canth., Merc. 

with Endometritis. — Merc, Puis., Sep., Amm., Calc, 

Chin., Con., Ferr., Lye, Sabin., Sepia, Sulph 

with suppressed Leucorrhcea. — Bry., Chin., Nux v., Puis., 

Sulph., Aeon., Ars., Bell., Lach. 

with suppressed Lochia. — Bell., Nux v. Puis., Secale, 

Hyos., Verat. 

with suppressed menses. — Con., Kali., Lye, Puis., Sulph. 



Special Therapeutics, 251 

Physometra: Phos ac, Sang. can., Bell., Chin., Calc, Hyos., 

Lye, Magn, e Nux v. Sepia. 
Moles : Puis., Secale, Canth., Calc, Sil. 
Hydatids: Calc, Sulph., Sil., Merc, Aeon., Ars. t Chin., Per., 

Graph. 
Sanguineous Concretions: Nit. ac, Phos., Stront. 
Lymphatic Concretions : Sulph. acid. 
Cancer of Uterus : Graph., Kreos, Sep. ; Ars., Sil, Sulph., Merc. 

Scirrhous : Carbo an., Sep.; Aur., Bell., Chin., Staph. 

Fungus of Uterus: Graph j Ars., Carbo an., Kreos., Lye, Sep., 

Staph., Thuja, Bell., Carbo v., Lach., Merc, Nit. ac, Phos., 

Sabin., Sil., Sulph. 
Bloody : Bell., Carbo an., Chin., Graph., Kreos., Sep.; Aur., 

Carb. v., Lach., Merc, Sil., Sulph. 
Medullary: Bell., Phos., Sil., Sulph.; Ars., Carbo an., 



China, Graph., Kreos., Merc, Sep. 
Ulceration of the Uterus. — See chapter on Ulcers. 
Gangrene of the Uterus: Secale ; Ars., Kreos., Carbo v. 
Ovarian Tumors: Acid .phos., Apis mel., Apocyn. can.; Ars., 
Canth., Chin., Colch., Dig., Dulc, Plater., Graph., Hell., Lod., 
Kali hyd., Lye, Merc, Plat., Prun., Sep., Scilla, Staph., 
Thuja., Uva ursi. 
Fistula: Puis., Sil., Lye, Calc; Assa., Carbo v., Bell , Nit. ac, 
Con. 

Aconite nap. I know of no local symptoms of any importance, 
save the profuse and long-lasting catamenia. 

Ammonia Carb. Itching, burning and swelling of the pu- 
denda ; fluor albus, burning, acrid and watery. 

Worse in the evening; also on bending down, and during wet 
weather. 

Better when lying on the stomach, or right side, lying on the 
painful side, from warmth, and in dry weather. 

Apis mel. Burning — stinging pain in the ovarian tumor; 
feeling in the bowels as if diarrhoea were coming on ; abdomen 
swollen and tender, with swollen feet and scanty secretion of urine, 
external tenderness even to the pressure of the bed clothes; bear- 
ing-down pain, as if the menses would come on, with aching and 
pressing in the hypogastrium ; coldness and anasarcous swelling of 
lower extremities; sharp, cutting, stinging pain in the swollen 
ovary, worse during menstruation; pressing-down pain in the 



252 Surgical Diseases of the Female Genitals. 

uterus ; dropsy of the uterus ; menstruation suppressed or dimin- 
ished, with congestion to the head. 

Worse in the morning; also from heat, and when in a warm 
room. 

Better from cold ; (cold water.) 

Arnica mon. Soreness and bruised feeling in the parts, as if 
after a difficult labor: useful in diseases arising from blows or falls. 

Arsenicum alb. For open cancer of the uterus, with burning 
and agonizing pains, secretion of fetid, brownish or blackish ichor ; 
fainting fits ; excessive debility, and rapid sinking of strength ; 
emaciation; burning pains, even felt while sleeping at night; 
general anasarca ; restless sleep, and frequent starting as if fright- 
ened ; the whole abdomen is painful, excessively so at night ; swel- 
ling and distension of the abdomen with burning pain ; frequent 
urging to urinate, with burning during micturition ; profuse acrid 
or corroding menses ; weakness and painful stiffness of the small 
of the back ; cramps in the legs ; weakness and debility of the 
lower extremities ; corroding and acrid leucorrhcea. 

Worse at night ; also from cold, and when lying on the painful 
side. 

Better from heat in general, and when lying with the head high. 

Asamm europeum. Nervous irritability; over-sensitiveness 
of the nerves, the scratching of linen or silk is insupportable ; sen- 
sation of lightness in the limbs, when she walks she feels as if she 
were gliding through the air. 

Worse in the evening ; also in cold and dry weather. 

Better from wetting the part. 

Aurum fol. In the beginning of cancer of the uterus, when 
there is falling of the womb, and pressure on the fundus of the 
bladder; alternate peevishness and cheerfulness; very sensitive 
to pain, and the cold air. 

Worse in the morning ; also on getting cold. 

Better from motion, while walking, and from warmth. 

Belladonna. In cancer, frequent hemorrhages from the womb, 
painful pressure on the parts, violent pains in the small of the 
back, and nervous excitement ; great pressure at the genitals as 
if everything would protrude ; stitches in the genitals ; dryness of 
the vagina ; congestion and inflammation of the uterus and labia ; 
intense cramp-pains in the small of the back and os coccyx. 

Worse in the afternoon and at night ; also on moving, and from 
the lightest touch on the parts. 



Special Therapeutics. 253 

Better while standing. 

Bryonia alba. Despair of recovery, irritable, and inclined to 
be angry ; swelling and inflammation of the left labia majora ; 
stitches in the hip-joint extending to the knee ; swelling of the 
lower extremities ; yellow skin. 

Worse in the evening ; also from motion, bodily exertion, and 
from heat. 

Better on getting warm in bed. 

Calcarea Carbon. Easily frightened or offended; stiches in 
the os uteri ; itching or pressing in the vagina; varices on the labia ; 
fluor albus like milk ; or, burning, itching, in starts, during mictu- 
rition, or before the catamenia ; pain in the small of the back as 
if sprained, can scarcely rise from his seat after being seated ; 
great weakness and debility from a short walk, or from talking ; 
fainting with loss of sight and coldness; sensation of coldness or 
dryness in inner parts. 

Worse in the morning and evening ; also in wet weather, in cold 
air, and from the pressure of the clothes. 

Better from loosening the garments. 

Cantharis. Excessive debility, trembling of all the limbs ; ver- 
tigo ; frequently a loss of thirst for days at a time ; aversion to 
every kind of drink; increase of appetite, though at times complete 
anorexia ; inclination to vomit ; cutting and heat in the abdomen ; 
violent pain in the abdomen ; sensitiveness of the abdomen to the 
touch ; sometimes constipation, and sometimes diarrhoea ; painful- 
ness and inflammation of the bladder; scanty secretion of hot 
urine ; constant ineffectual urging to urinate ; copious urination, 
attended by pain and burning ; gnawing in the small of the back ; 
" going to sleep " of the lower extremities ; inflammation of the 
ovaries ; swelling of the neck of the uterus ; over-sensitiveness of 
all the parts. 

Worse in the afternoon and at night ; also after drinking coffee. 

Better when lying down. 

Carbo animalis. In scirrhus of the uterus, with pressive 
pains in the loins, groins and thighs ; distension of the abdomen ; 
flatulence, frequent eructations, and desire to vomit ; fluor albus 
leaving yellow stains on the linen ; numbness of the limbs. 

Worse in the evening and at night ; also in the open air, and 
from cold. 

Better from warmth. 



254 Surgical Diseases of the Female Genitals. 

Carbo Vegetab. Restlessness and anxiety; sensitiveness and 
irritability ; nausea in the morning , itching, burning and soreness 
of the parts ; apthae and itching at the pudendum ; thick yellow- 
ish-white leucorrhcea ; varices of the vulva ; rheumatic tearing in 
the back ; painful stiffness in the back in the morning when rising; 
numbness of the limbs, they " go to sleep easily ; " great debility 
on making the least exertion. 

Worse in the forenoon ; also from cold. 

Better from warmth. 

China Off. The lower limbs become numb when lying on them ; 
tingling and numbness of the limbs ; some patients have a great 
increase of appetite, and others a complete aversion to all kinds 
of food ; inclination to vomiting and eructations after a meal ; 
oppressive and spasmodic pains in the stomach after a meal ; fre- 
quent urination ; scanty, dark-colored urine ; insupportable pain 
in the small of the back as if bruised or beaten to pieces ; weak- 
ness and lameness of the lower extremities ; congestion of the 
uterus, with feeling of fullness and painful pressing to, and sense 
of heaviness of the genitals, particularly when walking ; discharge 
of bloody urine from the vagina, alternating with discharge of pus ; 
painful induration in the vagina. 

Worse at night ; also from being touched if but lightly. 

Better after rising from the bed or seat. 

CoCCUlllS ind. Aversion to food; paroxysms of nausea, with 
tendency to faint ; tremor in the back : paralytic pain and paraly- 
sis of the back and small of the back ; the thighs feel paralyzed 
and bruised; disposition to tremble; great debility from slight 
exertion, and inclination to faint. 

Worse in the evening and at night ; also in the open air, and 
from talking. 

Better when lying down. 

ColchiClim aut. Sudden sinking of strength ; the legs feel as 
if they would drop off; loss of appetite; this aversion to food is 
increased on seeing it, still more on smelling it; great thirst; 
nausea with inclination to vomit; violent vomiting; oppression at 
the pit of the stomach; pain in the whole abdomen; colicky pains; 
great distension and swelling of the abdomen ; stools exceedingly 
painful, with disposition to diarrhoea; pain in the anus; increased 
secretion of brownish urine ; lacerations and lancinations in the 
back; cedematous swelling of the legs and feet. 



Special Therapeutics. 255 

Worse in the morning, and at night ; also while walking. 

Better when sitting or reposing. 

Conium mac. In cancer of the uterus, intolerable lancinating 
pains; frequent nausea, vomiting; fancy for odd things to eat, as 
in pregnancy ; inclination to start as if with fright ; acrid and burn- 
ing leucorrhcea, preceded by pinching pains in the abdomen ; pain 
as from a sprain, in the left side of the back ; sensation of debility 
in the morning when in bed ; sudden loss of strength while walk- 
ing. 

Worse in the morning and at night ; also while standing and 
when at rest. 

Better from moving about and when walking. 

Digitalis pur. General weakness and fainting fits ; want of 
appetite, nausea and inclination to vomit; vomiting in the morning ; 
vomiting of the ingesta, or of mucus ; lancinations from the pit 
of the stomach to the sides and back ; anxious tightness and con- 
striction about the hypochondria; pressure on the bladder; unsuc- 
cessful desire to urinate ; emission of only a few drops of urine 
after a great effort ; pain in the thighs and legs, with weakness and 
lassitude of the lower extremities. 

Dulcamara. Emaciation; lassitude; violent desire for cold 
drinks ; eructations and nausea after a meal ; vomiting of mucus 
in the morning ; a sense of inflation at the pit of the stomach ; 
cutting or pinching pain in the abdomen quickly passing away ; 
pinching around the umbilicus ; a stinging pain in the umbilical 
region ; slimy diarrhoea, looseness of the bowels with evacuations 
of white mucus ; painful micturition ; turbid whitish urine ; lame- 
ness of the small of the back as if from a cold ; bloatedness of the 
lower limbs ; weakness of the lower extremities. 

Worse in the evening ; also in the cold air, in wet weather, and 
when at rest. 

Better from moving about, after rising from a seat, and when 
walking in the warm air. 

Elaterium. Discharge from the bowels of frothy water ; dull 
olive-green discharges. 

Better from perspiration. A remedy that is little used, and of 
which, I think, as little is known. 

Ferrum met. Quarrelsome, disputative; vomiting of the ingesta 
as soon as she eats ; hemorrhage from the uterus, with labor-like 
pains in the abdomen and glowing heat in the face ; the blood is 



256 Surgical Diseases of the Female Genitals, 



partly pale and partly clotted ; painfulness in the vagina during 
an embrace ; swellings and indurations in the vagina ; prolapsus 
of the vagina; great emaciation ; so weak that she has to lie down ; 
restlessness of the limbs. 

Graphites. Emaciation; weakness of the limbs; excessively 
tired and drowsy ; oppressive headache early in the morning, when 
awakening bitter taste in the mouth, with little or diminished appe- 
tite; sleepiness after dinner; nausea and vomiting of theingesta; 
pressure in the stomach; stitches in both hypochondria; constipa- 
tion ; burning in the rectum, and itching of the anus ; passage of 
a quantity of white mucus mingled with the stool ; frequent emis- 
sion of turbid, urine; soreness of the pudendum; profuse white 
leucorrhoea ; violent pains in the small of the back as if from a 
bruise ; heaviness in the lower limbs ; Jahr adds to these, (in can- 
cer uteri,) warmth and painfulness of the vagina, engorgement of 
lymphatic vessels and mucous follicles, hardness of the neck of 
the womb, which is swollen and covered with fungous excrescen- 
ces ; heaviness of the abdomen, with exacerbation of the pains, 
and fainting when standing ; retarded and painful menses, with 
discharge of black, coagulated and fetid blood ; stitches through 
the thighs and hypogastrium, like electric shocks ; burning pains, 
constipation, earthy complexion, sadness and restlessness. Lippe 
adds, soreness of the vagina; painful swelling of the left ovary. 

Worse at night ; also from cold, and during and after menstrua- 
tion. 

Better after lying down. 

HelleborUS. Great increase of appetite ; vomiting of a green- 
ish-black substance ; intensely painful burning in the stomach ; 
bowels loose, with nausea and colic ; tendency to hemorrhoids ; 
frequent micturition, with small emissions ; stiffness and tension 
of the muscles of the thighs ; great weakness of the thighs and 
legs ; suppressed sexual desire. 

Worse in the afternoon and evening ; also in the cold air, and 
from bodily exertion. 

Better in the warm air. 

HyoscyaiTlUS nig. Voracious appetite and thirst; vomiting of 
blood and bloody mucus; distension of the abdomen, with pain 
when touched ; pain as from soreness in the abdominal walls when 
coughing; frequent desire to urinate, with scanty emission; men- 
struation too profuse with delirium ; before menstruation hysterical 



Special Therapeutics, 257 

spasms, with uninterrupted loud laughing ; metrorhagia, the blood 
pale with convulsions ; cramps in the anterior part of the thigh ; 
uncommon sinking of strength; repeated attacks of fainting; 
subsultus tendinum. 

Worse in the evening; also during menstruation. 

Better by stooping. 

lodill-m. Numb feeling in the thighs and legs; emaciation with 
hectic fever; extreme emaciation; sleeplessness; excessive canine 
hunger; in other cases want of appetite'; empty eructations; 
nausea, with vomiting of bile ; pressure in the region of the liver, 
the spot is painful to the touch; incarceration of flatulence; 
constipation, or irregular stools, sometimes loose, then costive; 
retention of urine ; stitches in the small of the back ; heaviness of 
the limbs; menstruation irregular sometimes too early, sometimes 
too late; leucorrhoea corroding the linen, acrid and profuse; 
induration and swelling of the uterus and ovaries ; great irritability 
of the whole nervous system ; trembling of the limbs. 

Worse in the evening, and at night; also from lying on the 
painful side, from pressure, from warmth, and in a warm room. 

Better from cold. 

Kali carb. Vexed and irritated mood, trifles vex one, noise is 
disagreeable; nausea as if she would faint; tension across the 
abdomen ; hard, distended abdomen, with tenderness of the 
umbilical region to the touch ; suppressed menstruation ; supres- 
sion of menses with anasarca and ascites ; the menstrual blood is 
acrid, makes the thighs sore, and covers them with an eruption ; 
yellowish, burning leucorrhoea, with pain in the small of the back, 
labor-like pains, and itching and burning in the pudendum ; a short 
walk is very fatiguing. 

Worse in the morning; also from cold air, and when lying on 
the side. 

Better on getting warm. 

Kali hydriod. Every little noise makes one start; the food has 
no taste; tastes like straw; cutting and burning around the 
umbilicus ; suppressed menstruation ; frequent urging to urinate 
when the menses appear; thin, watery, acrid, corrosive leucor- 
rhoea ; discharge of mucus from the vagina ; irresistible desire to 
go into the open air. 

KreaSOte/ Swelling of the labia, with itching in the vagina; 
stitches through the thighs like electric jerks; dark coagulated 



258 Surgical Diseases of the Female Genitals. 

menstrual discharges, followed by an ichorous and corrosive dis- 
charge ; painful pressure on the parts ; itching in the vagina in the 
evening, inducing rubbing, succeeded by smarting, swelling, heat 
and induration of the external parts, with soreness in the vagina 
when urinating; on the neck of the uterus a hard lump, and ulcer- 
ative pain during an embrace; during an embrace burning in the 
parts, and followed next day by menstrual discharge of dark blood; 
leucorrhcea, mild, corrosive, debilitating; pain as if the small of 
the back would break; pain in the small of the back like labor 
pains ; strong pressure to urinate, and ineffectual desire to go to 
stool ; pain in the back at night, worse on lying down ; humming 
and buzzing in the lower extremities ; faintness in the morning 
when rising too early; sensation of soreness, as if bruised. 

Worse in the morning; also in the open air, and on moving 
about. 

Better from warmth. 

Lachesis. Nervous irritability; nausea and vomiting of food ; 
vomiting of bile or mucus ; heat in the abdomen ; great discomfort 
from having the clothes tight around the waist; menstruation 
suppressed ; the uterus feels as if the os were open ; redness and 
swelling of the external parts, with discharge of mucus ; swelling, 
induration, pain and other anomalies of the left ovary; sexual 
desire excited ; pain in the os coccygis, when sitting down one 
feels as if sitting on something sharp ; trembling of the legs ; severe 
weather, either hot or cold, causes great debility. 

Worse in the evening ; also after sleep, and periodically. 

LyCOpodium Clav. Stiffness of the joints; weariness, extreme 
weakness and emaciation, with tremor of the limbs ; sleeps poorly ; 
starts on falling asleep ; hunger at times excessive, and again 
diminished ; nausea and vomiting ; nausea before breakfast every 
morning ; nightly vomiting of bile ; tension in the lower part of 
the region of the liver ; sore aching in the right hypochrondria ; 
drawing pain in the abdomen; gurgling in the abdomen; in- 
effectual urging to stool ; hemorrhage from the rectum ; frequent 
and painful urination ; urine has a reddish, brick-dust sediment ; 
pain in the small of the back ; stiffness and aching, or drawing 
pain in the back ; chilliness of the small of the back ; cold and 
heavy feeling in the limbs ; for open cancer with tearing stitches ; 
burning pains in the vagina after intercourse ; warmth and dryness 
in the vagina; bloody leucorrhcea. 



Special Therapeutics. 259 

Worse in the evening; also on lying down, while sitting, on 
beginning to walk, and from the pressure of the clothes. 

Better on getting cold, (and in the open air.) 

Magnesia Carb. Sad mood, with indisposition to talk; cutting 
and pinching in the abdomen; secretion of urine increased, is 
pale, watery, or green ; white sediment in the urine ; pressing 
towards the pelvis as if menstruation would come, with cutting in 
the abdomen ; menses too late, or suppressed ; menstrual blood 
thick, dark like pitch ; fluor albus of acrid white mucus, preceded 
by colic; pain in the back, and small of the back, at night, as if 
broken; sensation of being tired, especially in the feet, and when 
sitting; a short walk tires much. 

Worse at night ; also when at rest. 

Better from walking about. 

MerCUrillS. Disgust of life, great indifference to anything; 
sweat at every motion ; great inclination to sleep in the day time ; 
late and unrefreshing sleep at night; pain in the abdomen, 
the least touch aggravates it unbearably ; desire to urinate ; 
urine scanty, fiery-red, and of a sour smell ; griping or bruised 
pain in the small of the back; painful pressure in the thighs; 
menstruation too profuse, with anxiety and colic ; suppressed 
menstruation ; congestion of blood to the uterus ; swelling, heat, 
and shining redness of the labia; inflammation of the ovaries and 
uterus ; prolapsus vaginae ; fluor albus, purulent and acrid. 

Worse in the evening, and at night ; also from the heat of the 
bed, during perspiration, and when exercising. 

Better when at rest, when lying down, and from cold. 

Nitric acid. Irritable disposition ; vexed at trifles ; incontinence 
of urine ; urine is discharged cold ; soreness of the genitals ; menses 
too early, or suppressed menstruation; leucorrhcea acrid, offensive, 
like brown water; great debility, with heaviness and trembling of 
the limbs, especially in the morning. 

Worse in the evening, and at night ; also on awaking, and on 
touching the parts. 

Better when riding in a carriage. 

NlIX Vomica, Inclined to find fault and scold, morose and 
stubborn ; cannot bear the clothes tight about the hypochondria ; 
strangury, painful, ineffectual urging to urinate ; menses too early 
and profuse, with dark-black blood; congestion to, and bearing 
down of the uterus; inflammation of the uterus, and external 



260 Surgical Diseases of the Female Genitals, 

parts; pain as if bruised in the small of the back and back, so 
violent that she cannot move ; numbness, stiffness, and tension in 
the legs ; great debility of the nervous system, with over-sensi- 
tiveness of all the senses ; inclination to lie down, or to sit, with 
aversion to move about, or to the open air. 

Worse in the morning, and at night ; also from motion, and on 
being touched. 

Better from pressure, and when lying down. 

Phosphorus. Great excitability, becomes easily vexed and 
angry, from which she suffers afterwards ; soreness of the abdomen 
to the touch when walking; increased secretion of watery, pale 
urine; menstruation too early and too profuse, and of too long 
duration ; or, too early and too scanty, and watery ; stitches 
upward in the vagina, into the pelvis ; leucorrhcea acrid, drawing 
blisters and excoriating; great emaciation and nervous debility, 
and trembling in all the limbs from the least exertion ; over-sensi- 
tiveness of all the senses. 

Worse in the evening, in the night, and in the forenoon ; also 
when lying on the back, or left side. 

Better when lying on the right side, and after sleeping. 

Phosphoric acid. Perfect indifference : the uterus is bloated, 
as if filled with wind ; weakness of the legs ; great drowsiness. 

Worse in the morning and evening ; also from talking, and when 
at rest. 

Better from motion. 

Platina met. No appetite ; much thirst ; empty eructations in 
the morning ; continual nausea, with great languor ; anxiousness, 
with a trembling sensation through the whole body ; a writhing 
sensation around the umbilicus ; constipation ; difficult stool ; red 
urine ; pain in the small of the back as if broken ; feeling of weak- 
ness with tremulous uneasiness in the thighs ; pain in the thighs 
as if they were bruised; painful sensitiveness of the genitals, in- 
ternally and externally ; bearing down to the genitals, and pressing 
down in the abdomen ; unnatural excitement of the sexual desire, 
with voluptuous tingling in the external and internal sexual organs ; 
induration of the uterus ; menstruation too early and too profuse, 
lasting but a short time, with clotted dark blood ; metrorrhagia, 
with great excitability of the sexual system ; paralytic weakness in 
the limbs, especially when at rest. 

Worse in the evening ; also when at rest. 



Special Therapeutics. 261 

Better during motion. 

PrUflUS Spinosa. Cutting across the abdomen; tenesmus of 
the bladder; pain in the small of the back when sitting; tickling- 
itching in the region of the ovaries, not relieved by scratching or 
rubbing; menstruation too early, with violent pain in the small of 
the back ; metrorrhagia of thin, pale blood, becoming more watery 
the longer it lasts ; leucorrhcea excoriating, turning the linen yellow. 

Pulsatilla. Peevishness, which increases to tears ; menstruation 
too late, and too scanty, and of too short duration, with cramps in 
the abdomen; blood thick, black, clotted, or thin and watery; 
suppressed menstruation; metrorrhagia, with coagulated clotted 
blood, with false labor-pains, now stopping, and then stronger 
again ; leucorrhcea acrid, burning, like milk, and painless ; pains 
in the back, and chilliness from suppressed menstruation ; attacks 
of fainting, with great paleness of the face. 

Worse in the evening ; also from warmth. 

Better from cold, and in the open air. 

Rhus tox. Absence of mind; visible contraction in the abdo- 
men above the navel; frequent urging to urinate day and night, 
with increased secretion; diminished secretion of urine, although 
a great deal is drank ; bearing-down pain when standing ; cata- 
menia too early, too profuse, and too protracted; hemorrhage of 
clotted blood, with labor-like pains ; soreness and stitches in the 
vagina ; menstrual blood acrid ; pain in the small of the back when 
sitting still or lying; great debility, weakness and soreness, espe- 
cially when sitting, and when at rest. 

Worse in the morning; also when at rest, while lying down, 
during wet weather, when the weather changes, and from cold in 
general. 

Better when walking, from continued motion, and from warmth. 

Ruta graveolens. Inclination to quarrel and contradict ; gnaw- 
ing and eating pain about the navel ; frequent pressure to urinate, 
with scanty emission of green urine ; pressure on the bladder as 
if continually full, the pressure to urinate continues after micturi- 
tion ; menstruation irregular, followed by leucorrhcea ; corrosive 
leucorrhcea after the menstruation has ceased; pain in the back 
and on the os sacrum, as if bruised ; stitches in small of the back 
when sitting, walking or stooping ; sensation of soreness of the 
parts on which one lies. 

Worse in the afternoon? also during rest, and in cold we* 
weather. 



262 Surgical Diseases of the Female Genitals, 

Better from motion. 

Sabina. Low-spirited and joyless; soreness of the abdominal 
muscles ; pressing down towards the genitals ; frequent and violent 
urging to urinate, with profuse discharge ; menstruation too early 
and too profuse ; hemorrhages with partly pale-red, partly clotted, 
or of very thin, discolored, offensive smelling-blood ; very offensive- 
smelling leucorrhcea, after suppressed menstruation ; stitches deep 
in the vagina ; increased sexual desire almost amounting to nympho- 
mania ; labor-like pains, drawing down into the groins ; twitching 
pulsation in the blood vessels. 

Worse in the morning, and in the evening ; also on motion, or 
when standing up. 

Better when lying perfectly still. 

Sangumaria can. Angry irritability, moroseness ; pain in the 
left hypochondria, worse when coughing, and better when lying on 
that side, or from pressure ; frequent and copious nocturnal urina- 
tion, urine clear as water ; menstruation too early, with a discharge 
of black blood ; amenorrhcea ; uterine hemorrhage ; flatulent dis- 
tension of the abdomen in the evening, with escape of flatus from 
the vagina, the os uteri being dilated ; bruise-like'pain in the thigh, 
alternating with burning and pressure in the chest; great debility, 
with weakness in the limbs while walking in the open air ; weak- 
ness with palpitation of the heart, fainting weakness. 

Worse in the morning, and in the evening ; also from motion. 

Better when lying still. 

Scllla maritima (Squilla). Restless sleep; complete loss of appe- 
tite ; empty eructations ; hard, scanty feces ; great desire to urinate, 
with rather scanty emission; the thighs feel as if bruised; jerking 
of the limbs when sitting; painful sensitiveness of the abdomen, 
in the region of the bladder. 

Worse in the morning ; also from motion. 

Secale COmiltum. Great anxiety; pains in the groins, as from 
false labor-pains ; urinary secretions suppressed ; pale, watery 
urine ; menstruation profuse, and of too long duration ; hemor- 
rhage from the uterus of black liquid blood ; swelling of, and warts 
on the half-open uterus ; inflammation of the uterus from sup- 
pressed lochia, or menstruation ; tingling in the back, which is 
numb, devoid of feeling, extending to the tips of the fingers. 

Worse at night ; also from motion, on touching the parts, from 
walking, from warmth, and on getting warm in bed. 



Special Therapeutics. 263 

Better in the open air, and whilst standing. 

Sepia. For soft (?) scirrhous ; with painful pressure downwards, 
with burning in the parts, eruptions on the inside of the labia, 
soreness and redness of the vulva; lancinating jerks, from the 
fundus of the vagina to the umbilicus ; frequent bloody discharges 
between the periods, especially after intercourse ; putrid leucor- 
rhcea, (Jahr). Pressure at the genitals as if everything would 
protrude; induration of the neck of the uterus; violent stitches 
in the vagina upwards ; redness, swelling, and itching humid erup- 
tion on the labia ; catamenia too early and profuse, or too scanty 
or suppressed ; leucorrhcea of yellow or greenish water, like pus, 
or bad smelling fluids ; weakness of the small of the back when 
walking; pulsation in the small of the back; heaviness in the 
body ; a short walk fatigues much ; aversion to the open air ; want 
of natural heat ; weakness of the joints. 

Worse in the forenoon, and in the evening ; also when at rest, 
when sitting, from sexual excesses. 

Better from warm air, and from violent exercise 

Staphisagria. Weakness of memory; sensation of weakness 
in the abdomen, as if it would vanish ; profuse discharge of watery, 
pale urine, with much urging; painful sensitiveness of the sexual 
organs, especially when sitting; violent stitches upwards in the 
back; pulsative pain in the region of the hip-joint as in commenc- 
ing suppuration ; stiffness and sensation of fatigue in all the joints 
in the morning. 

Worse in the morning, forenoon, and at night ; also from sexual 
excesses, and from touching the parts. 

Better while lying down in bed. 

Strontiana Carb. Ill-humor, with inclination to anger and 
impetuosity; urine pale, strongly smelling of ammonia; menstrua- 
tion retarded, the discharge being serous at first, later clots of 
blood are passed; sensation of being bruised in the back and 
sacrum ; great emaciation. 

Worse in the evening, and at night ; also from cold. 

Better in the open air, in the sun, and from warmth in general. 

Sulphur. Peevishness, irritability, restless, quick temperament; 
movements in the abdomen as from the fist of a foetus ; retention 
of urine; frequent micturition at night; discharge of urine only 
by drops; foetid urine, with a greasy pellicle on it; menstruation 
too late, of too short duration, too scanty or suppressed; men- 



264 Surgical Diseases of the Female Genitals. 

strual blood acrid, corroding the thighs, smelling sour, or else too 
pale ; bearing-down in the pelvis, congestion to the uterus ; leucor- 
rhcea of yellow mucus, corroding, preceded by pains in the 
abdomen ; pain in the small of the back, on rising from a seat ; 
gnawing pain in the small of the back ; pain in the small of the 
back not permitting one to stand erect ; weakness of the joints. 

Worse in the evening, or after midnight ; also on getting warm 
in bed, from exertion of the body, from talking, while at rest, when 
standing, and from touching the parts. 

Better during motion, when lying on the right side, from heat, 
and in dry weather. 

Sulphuric acid. Restlessness and irritability; Jahr says, in 
most cases, (of cancer) at the onset, especially in open cancer, 
with violent burning pain in the vagina. Lippe : Pain in the 
abdomen like labor, extending to the hips and back ; menstruation 
too early and too profuse; impotence, with too early and too pro- 
fuse menstruation; leucorrhcea acrid or burning, or like milk; 
stiffness of the back on rising in the morning ; painful weakness 
of the knees ; weakness of the whole body, with a sensation of 
trembling. 

Worse in forenoon, evening, and at night; also in the open air. 

Thuja Occident. Movements in the abdomen as if from some- 
thing alive, or as if the muscles were pushed out by the arm of a 
foetus, but painless ; profuse perspiration before menstruation ; 
foaming urine, the foam remaining a long time; beating and 
pulsating in the back ; when walking the limbs feel as if made of 
wood. 

Worse in the evening, and at night ; also from cold-wet, and 
from the heat of the bed. 

Better from warm-wet, and from turning from the left to the 
right side. 

Uva UPSi. The indications are not characteristic, and of very 
doubtful authority. I presume it is used empirically. 

Veratrum album. Great sensitiveness of the abdomen to the 
touch ; suppressed urinary secretion ; continuous urging to urinate : 
catamenia too early, and too profuse ; suppressed menstruation ; 
on appearance of the menses, diarrhoea, nausea, and chilliness; 
before mentruation headache, vertigo, night sweat, and epistaxis ; 
during the menses, morning headache, nausea, ringing in the ears, 
thirst, and pain in all the limbs ; suppressed lochia, with delirium; 
nymphomania of lying-in women ; back and small of back feel 



Special Therapeutics. 265 

sore as if bruised ; sudden sinking of strength ; continuous weak- 
ness and trembling. 

Worse in the morning ; also during perspiration and after sleep. 

Better after perspiration. 

Operations. 

Entero-vaginal fistula had better be let alone. All the other 
varieties of fistula opening into (or from) the vagina, are curable 
by operation. The main object in these operations is, to prevent 
the passage of feces or urine through the vagina. For this pur- 
pose the fistula must be made to heal from the bottom. If the 
opening be circular or oval, the shape must be changed. Introduce 
a bivalve speculum into the canal, and with a long-handled knife 
remove an elliptical-shaped piece of the coats through the entire 
thickness of the walls ; this must include the hard callous edges ; 
draw the freshened edges together. One of the greatest difficulties 
formerly, was the impossibility of getting the sutures to hold long 
enough for the wound to unite. Dr. Marion Sims has overcome 
this, by the introduction of his "button suture." When a stitch 
is passed through in the ordinary way, there is constant danger of 
its cutting its way out before union has been established ; by his 
method, the two ends are passed through the holes of an ordinary 
button, and if wire, are then twisted together by forceps; if of 
silk, a split shot is applied with pliers. The after treatment will 
consist in the administration of Stafihisagria, and enjoining perfect 
cleanliness on the part of the patient and nurse, with perfect quiet 
on that of the patient. The bowels must be kept perfectly im- 
movable, and in urinary fistula, a catheter must be constantly worn, 

Ovarian tumors are removed by making an incision through the 
linea alba, from the umbilicus nearly down to the pubis. The 
cysts are then emptied with a trocar and canula, one at a time, 
and, for the sake of accuracy in keeping your " notes," the fluid 
is measured as it comes away. A carbolized cat-gut ligature may 
be passed through the pedicle of the mass doubled, and tied tightly 
on both sides, or the vessels closed by torsion. The whole is then 
removed, by some with the knife, but by many others with the 
ecraseur. The same precautions about dividing the fascia and 
peritoneum are to be observed as in hernia. Avoid all unnecessary 
handling of the exposed parts, as peritonitis, inflammation of 
other tissue, and gangrene are very commonly met with, and fre- 
quently carry off vour patient. 



266 Surgical Diseases of the Joints, 



SURGICAL DISEASES QF THE JOINTS. 






SYNOVITIS, ARTHRITIS, WHITE-SWELLING, ANCHY- 
LOSIS, HIP-DISEASE, ENLARGED BURS^E, GAN- 
GLIONS, WOUNDS, DISLOCATIONS, STRAINS. 

Synovitis. 

This is an inflammation of the synovial membrane. It may be 
acute or chronic, traumatic or (so-called) idiopathic. The causes 
are exposure to cold, or some direct injury. To the first cause 
rheumatic and syphilitic persons are peculiarly liable. The syn- 
ovial fluid is not only increased in quantity, but also in fluidity ; 
and when the swelling is great it is known as hydrarthrosis. The 
simple form usually terminates in resolution, but may result in an 
abscess. The gravity depends upon the size of the joint. Sup- 
puration is the one thing to be dreaded in all cases. The symp- 
toms are, pain, heat, redness and fluctuation. The pain is usually 
severe, not admitting of pressure, motion, or even the lightest 
touch. In rheumatic synovitis, the pain is of a gnawing character. 

Arthritis. 

Gout is an inflammatory condition of the structures of a joint. 
The pathological conditions are interesting as pathology, but can 
aid us but little in treatment. The cartilages are primarily and 
most severely affected, and anchylosis often results. It is often 
hereditary, and when not so rarely makes its appearance before 
the 'age of thirty-five, though if transmitted, it may, and usually 
does, appear much earlier. It is not confined to any particular 
locality of the body, although the joints are principally affected. 
Some, or any of the internal organs may be so diseased by metas- 
tasis, but rarely primarily. Among the exciting causes, when 
there is arthritic tendency, may be enumerated wounds, strains, 
exposure to cold, etc. Frequently concretions form, which may 
force themselves through the skin, and are usually composed of 



Wh ite - Swelling. 267 

urate of soda. Nodosites also are a usual occurrence. Several 
joints may be affected at the same time, and the pain, without pos- 
itively intermitting, has a periodical aggravation, and partial remis- 
sion. 

In common, there is pain, heat, and swelling. The pain is throb- 
bing and tensive, and is very acute ; the slightest touch or motion 
is excruciating, so that heavy walking, the jarring of the bed, or the 
rumbling of vehicles in the street is insupportable. The suffer- 
ings are usually more severe at night. The pain is felt 
more particularly at certain spots in the joint, as the inner and 
under side of the knee, or the outer side of the hip. The swell- 
ing is uniform, including the whole joint ; while in synovitis, it 
projects in certain parts. Unlike synovitis again, there is no fluc- 
tuation, but the part has a doughy feel and is soft. This swelling, 
however, sometimes increases rapidly, and is due, perhaps, to the 
presence of pus in the joint, or to an, increase of the synovia. 
Abscesses sometimes form, from the effects of which the synovial 
membrane gives way, and we have an enormous diffuse abscess, 
which burrows for a long distance. I have seen one formed in the 
hip and point in the popliteal space. As in hip-disease, the joints 
involved sometimes become spontaneously luxated. The positions 
of the limb are also peculiar, being that which will afford the most 
relief, as the knee flexed and thigh abducted, and the elbow bent. 
One of the most important conditions is to preserve a perfect rest, 
and avoid all stimulating or heating diet. Rest, perfect and abso- 
lute is the prime indication, and without it any treatment will be 
abortive. 

White-swelling. 

By this term we understand a thickening of the joint, colorless 
swelling, weakness, with little or no pain ; the remainder of the 
limb atrophied, and the whole appearance indicating the presence 
of struma. Any joint in the body may be affected by this disease 
but the knee is oftenest the chosen seat. The termination is rarely 
by resolution ; oftener the cartilages are destroyed, caries or necro- 
sis of the bone are the result, with unhealthy suppuration and 
consequent destruction of the articulation. Like many other dis- 
eases of this nature, the occurrence is rarely idiopathic, but usually 
the amount of injury sustained is so slight that its traumatic origin 
is not suspected. Liston and Gross, considering it a symptom 
of scrofula, discarded the term from surgical nomenclature. 



268 Surgical Diseases of the Joints 

ANCHYLOSIS. • 

By this we understand an immovable joint. It may be partial 
or complete. When the former, it may be ligamentous, or if care 
be taken in the examination, it may be found to be contraction of 
the muscles. When complete it is osseous, and I believe incur- 
able, by any kind of treatment, except possibly, by an operation. 
The causes for this condition have been referred to in the preced- 
ing pages. 

Hip-disease. 

" Coxalgia," or " morbus coxaria," is an inflammation of the hip 
joint, with destruction of the cartilages, spontaneous dislocation, 
and destruction of the joint. I am unable to see in what respect 
this disease differs from white-swelling just considered. The 
effects and causes are identical, as far as I can learn, and certainly 
the treatment, as far as we are concerned, is not changed in con- 
sequence of its having a new name. The symptoms, then, are not 
at all peculiar. They are pain, swelling, and inflammation ; per- 
haps suppuration and shortening of the limb, real or apparent. 
The pelvis may be distorted, or the spine curved, and these parts 
must be well looked to before pronouncing an opinion. In the 
early stages, pain is often felt in the knee ; but as this joint looks 
healthy while the hip does not, there need be no confusion. 
Abscesses form at various points in the vicinity, and from their 
extent and severity frequently carry off the patient from exhaus- 
tion. 

Enlarged burs^e. 

BurSjE from pressure or long continued misuse of the part upon 
which they are situated, become inflamed, forming painful and 
fluctuating tumors, oval in shape. After a time they become 
harder from a solidification of their contents, and resemble ordi- 
nary tumors. Not unfrequently they suppurate and are destroyed 
in that way ; but when recent the pain is very severe, although 
there is a considerable amount of pain at all times. 

Those tumors known as bunions are a common variety of this 
affection. 

Ganglions. 

These bodies are found in the vicinity of tendons, their chosen 
position being the wrist. They are smooth, globular and elastic, 



Wounds of the Joints. 269 

and quite movable. Usually there is no pain, unless they are 
handled or pinched, when a dull pain is felt. If a nerve be 
pressed upon by them, however, pain and the symptoms usually 
resulting from such pressure will be felt. They may be simple or 
compound. When simple, (which variety is the most common,) 
they consist of a cyst filled with a clear transparent fluid, and 
varying in size from a pea to that of an ordinary cherry. The 
contents are usually yellow in color, and varying in consistency 
from a thin water to a substance like jelly. Compound ganglia 
are a mere distension of the sheaths of the tendon, and are con- 
sequently more irregular and attain a larger size. 

Wounds of the Joints. 

Wounds of joints are troublesome injuries to treat; anchylo- 
sis, and a train of evils consequent upon opening a joint, are all 
of them very obstinate. If we notice the escape of the synovial 
fluid, we may be certain the joint is opened; in many very severe 
cases, we find the articulation exposed. The symptoms of these 
injuries are very severe, and of course depend in a great measure 
upon the size of the joint opened; that of the knee is the most 
serious; anchylosis, suppuration of the joint, necrosis, or even 
death may follow ; but in the case of the fingers, but little impair- 
ment of function will follow. The nature and extent of the wound 
also must be taken into consideration, in forming a prognosis. 
Incised wounds are not as formidable as punctured, although they 
look much more so ; an incised one can be healed right up, and 
we have a better chance to prevent suppuration. In this variety, 
close it immediately, and use pins, or silver wire in preference to 
silk ; keep the part wet with cold water, and give Aeon. 6, in water, 
one spoonful every hour. After this treatment has been employed 
for twenty-four hours, suspend it, and use the topical Staphisagria 
treatment. If this is insufficient to keep the inflammation in check, 
Staphisagria 30, internally, will be the remedy. I have sometimes 
had good results from the external use of crude Petroleum, but am 
not inclined to recommend its general use. As an exception to 
the general rule, if suppuration threatens, do not by any means pro- 
mote the secretion of pus j exhaust the Materia Medica in trying to 
prevent it. Should it come, however, the only chance of saving the 
joint is to lay it open, and commence de novo. By this means we 



270 Surgical Diseases of the Joints. 

ensure a stiff joint, but lessen the danger of caries or necrosis. 
The best remedies for this danger are : 

From incised wounds. — Calend., Staph., Rhus. 

From punctured wounds. — Calend., Merc, Ruta; Petrol., Stram. 

In the case of punctured wounds, Calend. is not as useful as 
some other remedies. Stram. is more in favor with the profession. 
Of late the crude Petroleum, not the white, gummy substance, but 
the black, pitch oil, just as it comes from the wells, has been used 
with very good results. Dilute it, in the proportion of one to ten, 
with Sulphuric ether, and use it as a lotion. 

The question of amputation is a serious one in these cases ; it 
is too often resorted to by some, and too little by others. When 
the joint is large, the patient has not a strong constitution, the 
injury extensive, accompanied by lacerations, fractures, disloca- 
tions, amputation, except in some rare cases, is imperatively 
demanded. 

Blows and kicks are often productive of serious bruises about 
the joints. , 

Dislocations. 

Dislocations, otherwise called luxations, are displacements of 
two or more bones. A dislocation may be accidental, from external 
violence, or spontaneous, from disease. It may also be incomplete, in 
which case the displacement is but partial, and not necessarily 
conjoined with rupture of the ligaments : or complete when the lig- 
aments are torn, and the bones completely out of their natural 
relations. When an external wound exists at the same time, it is 
called a compound dislocation ; and if arteries or nerves are torn, 
or a bone fractured, it is termed complicated. 

It is frequently the case that a very slight force will induce a 
dislocation of a large joint, so that caution must be used in mak- 
ing a diagnosis. A boy was struck on the hip by an apple falling 
from a tree. The blow was a slight one, but careful examination 
revealed a complete dislocation of the femur. 

The most constant signs are pain, immobility more or less com- 
plete, and distortion of the limb. Pain is often more violent in 
inverse proportion to the amount of injury sustained, or rather to 
the completeness of the luxation. Thus there is oftentimes more 
pain in a partial dislocation of the semi-lunar cartilages of the 
knee-joint, than in a complete luxation of the hip. Immobility, on 



Disloca tions, 271 

the contrary, seems to be greater the more complete the displace- 
ment. This is true also of deformity. ' 

Having correctly diagnosed the case, let us consider the indica- 
tions to be fulfilled in curing it. These indications are reduction, 
retention, and restoration of the joint. 

Reduction is to be accomplished with the least possible exertion 
of force — violent effort, as the use of pulleys, only complicates the 
case, as the irritability of the muscles is much increased, and 
injury may be inflicted on the muscles, bloodvessels, or even the 
bones, very readily. A thorough knowledge of the mechanism of 
the joint is indispensable. By producing profound anaesthesia, 
gentle manipulations will invariably, almost, return the bone — 
of course these manipulations vary in the different joints, and 
cannot be given here, but this general rule may be laid down : 
First place the limb in such a position that the muscles are 
thoroughly relaxed ; then fixing the shaft near the luxated extremity, 
over some fixed point, (or if none exists, over the hand,) the shaft 
is converted into a lever, and the extremity lifted or rotated — as 
the case may be — into its proper place. 

Having thus reduced the luxation, we must now consider the 
means to be used to accomplish retention. They must be as simple 
as is consistent with safety. I make it a rule, in all cases except 
the shoulder perhaps, to dispense with bandages, or any heating 
and unyielding dressings or splints. Secure extension and coun- 
ter-extension, and lay a bran or sand-bag on each side of the limb. 
A. limited amount of motion is valuable in place of being hurtful. 

The luxation has now been reduced, and the joint retained, but 
we have still to cure our case ; that is to restore the tonicity of 
the parts involved, or to heal any lesions they may have sustained. 
Rest does a good share of this, but well-selected remedies hasten 
it. Rhus and Ruta are oftenest indicated in partial dislocations. 
R/ius, when, joined to the usual symptoms of a sprain, there is 
irritation of the skin, a fine vesicular rash, and a feeling as if at 
every motion of the joint {ankle f) the bones spread apart. 

Should there be much laceration of the soft parts, Calend. is the 
remedy. In fracture complications, Syinphyt. 

Should an artery be torn, it must be tied of course. It is a 
matter of considerable difficulty to detect this injury, and fortun-r 
ately it but rarely occurs. Should gangrene threaten, from a 
wounded artery cutting off the supply of blood, and the tissues in 



272 Surgical Diseases of the Joints. 

the neighborhood being much torn or contused, Ars. or Lack, in 
connection with external heat may save the limb. I recommend 
the use of all these remedies in the higher attenuations, and inva- 
riably trust to them alone without any external medicated lotions. 

A serious question sometimes arises in complicated dislocations, 
viz : whether the limb can be saved or not. It is a question of 
such magnitude, that it is not safe to act on your own opinion 
when counsel can possibly be had. Two facts must always be 
borne in mind : 

1 st. — It is as much an error to neglect to amputate when needed, 
as to perform it when it might be avoided. 

2nd. — Nature can and does perform some most wonderful cures 
in what would seem to be the most hopeless cases, when aided by 
rational treatment. Let me cite one case to support this : 

A carpenter fell from the roof of a building, sustaining a com- 
plete complicated dislocation of the right ankle — the sole of the 
foot looked almost directly upwards, integument torn so the joint 
was open, all the internal ligaments upturned, and the fibula frac- 
tured. Reduced. Treated with Calendula, followed by Sympht. 
Recovering with an anchylosis of course, but a singular compen- 
sation occurred. He has a complete joint at the meta tarso 
phalangeal articulation. 

Strains. 

Injuries to Muscles and Tendons consist in rupture or strain. 
The rupture of a muscle or tendon, is quite a common thing, and 
may occur in all degrees of severity. A partial rupture is not 
readily diagnosed, but when it is complete, the question is quickly 
decided. When an accident of this kind occurs, perfect rest, and 
a position that will ensure complete relaxation of the muscles, is 
necessary. The subsequent treatment is that for repairing severed 
parts after sub-cutaneous operations. Calendula 30th, or even 
higher, will be found very useful in this connection. There is but 
little risk of any unpleasant consequences, save the danger of 
contraction of the muscles, which a good position during the 
treatment will avoid. These injuries are nothing but an aggra- 
vated form of sprain. 

Strains are violent twisting of the soft parts surrounding a joint; 
they may be a stretch of the muscles only, or of the tendons, the 
ligaments, or even a partial dislocation. The accident is most 



Strains, 2 73 

commonly met with in the ginglymoid joints, and in some people 
is an accident frequently repeated. It has happened sometimes, 
that one of the vessels of the joint has been ruptured, thus pro- 
ducing heat, ecchymosis, and other troubles of a like nature. I 
am opposed to local treatment in any cases save those of wounds 
alone. I should recommend then, to maintain perfect quietness 
on the part of the patient, and the internal use of remedies alone. 

The remedies most frequently used are, Arnica, Bryonia, Conium, 
Natrum mur., Petroleum, Rhus fox., Ruta g., Sulph. 

Arnica. Hot, hard, and shining swelling of the part affected ; 
red, blue, and yellow spots, like ecchymosis ; painful lameness in 
the joints; disagreeable sense of dull tingling, or dull pain in the 
affected part. 

Bryonia. Heaviness, and weakness in the limb; trembling of 
the limbs, when rising from a recumbent posture ; stiffness of the 
joints; weakness; loss of strength on making the least effort ; red- 
ness of the part, with pain as if luxated, or sprained by lifting, or 
wrenching ; ecchymosis, with swelling, and stinging. 

Conium mac. Crampy, and spasmodic pain in the part; violent 
pain as if from bruises in the limbs ; lacerating in the sprained 
part; pulsative jerking; want of animal heat; chilliness. 

Natrum mur. Sprains with apparent shortening of the tendons ; 
drawing and pressure in the part ; inflamed and smarting ; feeling 
as if the flesh were detached by blows ; feeling as if the part had 
gone to sleep ; on stepping on floor, feels as if he were walking on 
red-hot coals. 

Petroleum. Cracking of the joints, with stiffness; paralytic 
drawing with pressure; the arms and legs go to sleep easily; 
weakness of the joints ; pains in the limbs as if bruised ; stitching 
pain, or as if from a splinter in the part. 

RHUS tOX. Some time ago, I had a patient who, whenever she 
had her ankle sprained, suffered with a peculiar pain, which lasted 
for days, or even one or two weeks ; this pain I removed any time 
in twenty-four hours. It is a symptom that you will not find in 
the Materia Medica; sensation as if the bones of the ankle were 
split, and spreading apart when she stepped on that foot, closing again 
on raising it; other indications are: swelling of the parts, with 
inflammation and stinging ; the pains are worse on beginning to 
move ; go off after motion ; stitching in the joints ; lacerating draw- 
ing in the parts ; lameness of the ioints. 
18 



274 Surgical Diseases of the Joints. 

Rllta graveolens. Bone pains, burning and gnawing in the 
periosteum ; pains in the joints as after a fall, or contusion ; pain 
in the bones of the wrist joint, as if bruised, both during rest and 
motion ; heaviness, and weakness of the limbs. 

Sulphur. Drawing pain in the limbs in the evening; sticking 
pains in the joints ; violent drawing and lacerating in the knees ; 
pains with great swelling ; also pains with no swelling ; redness, 
numbness, or burning of the parts ; itching, stinging, smarting, and 
swelling. 

Treatment. — In conducting the treatment of diseases of the 
bones and joints, there must be no frittering away of important 
time with topical treatment; use the remedies internally alone. 
In diseases of the joints consult the following : 
Synovitis: from Cold. — Aeon., Bell., Bry., Cham., Chin., Dulc., 
Graph., Lye., Merc., Nux v., Puis., Phos., Rhus, Sep., Sulph., 
Verat. 

from Injury. — Arn., Baryt., Con., Hep., Rhus, Ruta, Staph. , 

Sulph. 

from Syphilis. — Apis, Ars., Hep., Merc., Nil. ac., Sulph. , 

Thuja. 

from Scrofula. — Ant. e, Apis, Ars., Aur., Baryta, Bell. y 



Calc. c, Car bo v., Dulc, Hep., Iod., Kali, Lye, Merc, Nit. ac, 

Nux v., Phos., Puis., Rhus, Sep., Sil., Sulph. 
Arthritis: Aeon., Bry., Puis.; Arg., Am., Aur., Calc, Clem., 

Colch., Coloc, Con., Guaj., Hep., Iod., Kali, Led., Lye, Mang., 

Mezer., Phos., Rhod., Sabin. 
Arthritis Vaga : Am., Asa/., Mang., Nux mos., Plumb., Puis., 

Rhus. 

Nodosities. — Agn. c, Ant. c, Aur., Bry., Calc, Calc. phos.. 

Graph., Led., Lye, Phos., Rhod., Sabin, Sep., Sil., Staph., Zinc. 

Contractions. — Bry., Calc, Coloc, Guaj., Rhus, Sil., Sulph. 

from Working in Water. — Calc, Puis., Sarsap., Sulph.; 



Ars., Ant. c, Dulc, Nux v., Rhus. 

— Precursory Symptoms. — Nux v. 

— Recent Metastasis. — Bell. 



White Swelling : Aeon., Apis, Am., Ars., Bell., Calc, Con. 

Graph., Hep., Iod., Lye, Merc, Nux v., Phos., Puis., Rhus, 

Ruta, Sil., Sulph. 
Anchylosis: Aeon., Am., Ars., Borax, Bell., Bry., Kali, Mere, 

Rhus, Ruta, Sil., Sulph. 



Special Therapeutics. 275 

Hip Disease; Am., Ars., Bell., Bry. y Calc, Coloc, Hep., Merc, 

Puis., Rhus, Sulph. 
Enlarged Burs^e : Apis, Ars., Bell., Hep., Merc., Sil., Sulph. 
Ganglions: Apis, Am., Ars., Baryta, Bell., Con., Kali., Merc, 
Ruta, Sulph., Thuja. 

Aconite. Swelling and burning heat of the joint; bruised pain 
in shoulder and hip-joint ; drawing pain in elbow joints ; weakness 
in region of head of femur, with inability to walk, and a feeling as 
if it had been crushed, particularly after lying down and sleeping ; 
unsteadiness of the knees, they totter* and give way when walk- 
ing; tearing in the knees as if from a jerk in the inner side; the 
joints feel painful as if attacked with inflammatory rheumatism; 
swelling and burning heat of the skin of the affected parts ; burn- 
ing, tingling, and piercing jerks in the lower jaw; painful boring 
to the left of the lumbar vertebrae ; aching pains in the left half of 
the cervical vertebrae. 

Worse in the evening, and at night; also in the warm room, and 
when rising. 

Better in the open air, and when at rest. 

AgnilS C. Lacerating pain in the joints of the arms; swelling 
of a finger-joint, with lacerating pain; pain in right hip-joint, 
violently increased during motion, with debility and weariness; 
shooting-drawing in the knees and muscles ; tearing in the anterior 
joints of the left toes. 

Worse in the evening; also on motion. 

Better from strong pressure. 

Antimonium Crud. Red, hot swelling of the joint; blotches 
and vesicles as if from the stings of insects, in joints ; drawing 
pain in the finger-joints ; also in hip-joint ; stiffness of knee. 

Worse at night; also from heat of the sun. 

Better when at rest. Left side. 

Apis mel. (Have cured the following: Arm painless; elbow 
swollen, red, erysipelatous; fine burning-pricking in the skin; 
hand looks like wax, and on attempting to lift it, it trembles so that 
it must be held ; inability to move the shoulder-joint ; swelling 
extends for some distance above and below the joint). Sensitive- 
ness to the touch ; coldness and swelling of the legs ; oedematous 
swelling of the joints. 

Worse in the morning, and at night; also from heat. 

Better from cold water. Left side. 



276 Surgical Diseases of the Joints, 

Argentum met. Feeling of lameness in the elbow -joint; 
lameness in the hip-joint and thigh, when walking; cramp-like 
lacerating in the knees ; pain as if bruised, and throbbing in the 
joints of the feet. 

Worse at noon ; also from motion. 

Better when at rest. 

Arnica mon. Heaviness in all the limbs, with painfullness in 
the joints as if bruised ; pain as from a sprain in the wrist-joint * 
also in the hip ; stitches in the knee ; pricking in the knee when 
touched ; lacerating in the joints of the leg ; hot, hard and shining 
swelling of the affected parts ; painful concussions in the limbs 
when riding in a carriage, or when stepping hard on the ground. 

Worse in the morning, and at night ; also on moving, from being 
touched, and from cold. 

Better from warmth. 

Arsenicum alb. Drawing and lacerating in the joints of the 
arms, particularly at night; lacerating in the hips; tearing or 
drawing lacerating in the knee-joints, and tarsus ; stiffness of the 
knees and feet ; tearing in the bones ; burning in the bones ; pain 
as if the bone were swollen, or interstitially distended ; pain as if 
from an ulcer in the bone. 

Worse in the morning, and at night; also from cold. 

Better from warmth. 

Asafoetida. Intermittent, pinching, pulsative, or oppressive 
darting pains ; also lacerating pains from within outwards, either 
relieved by touching the parts, or transformed into different kinds 
of pains ; dark-red, hot swelling of the parts ; stitches in the 
shoulder ; also in the elbow ; lacerating around the hip-joint when 
walking ; inflammation of, with curvature of the bones ; scraping 
and boring in the periosteum ; violent painfulness of the bone to 
the touch. 

Worse in the afternoon and evening; also to the touch, and 
while sitting. 

Better in the open air. Left side. 

Alirum met. Dropsical swelling of the joint ; fine stitches in 
the shoulder ; lacerating pain in the wrist ; lameness and pain in 
the hip-joint, only when raising from a seat, and walking ; pain 
in the knees as if tightly bandaged. Nightly bone-pains ; inflam- 
mation and ulceration of the bones; bony tumors on the head, 
arms and legs; the bones of the skull are painful when lying 



Special Therapeutics. 277 

down ; small exostosis on the head, with boring pain, increased 
when tumor is touched ; the right nasal bone, and adjoining parts 
of the upper jaw, are painful when touched ; violent lacerating in 
the malar bones ; caries of the palate, with bluish ulcers. 

Worse in the morning ; also from cold, and when reposing. 

Better when moving, and from warmth. 

Baryta Carb. Pain in the elbow, as if from a contusion. Bone- 
pain at a small spot on the upper arm, as if an ulcer would form 
there ; lacerating and tension in the bones of the lower extremi- 
ties down to the heel ; drawing pains in the bones of the legs. 

Worse at night ; also when sitting, and when lying on the painful 
side. 

Better when walking in the open air. 

Belladonna. Erysipelatous swelling of the parts, with heat, 
redness and inflammation ; lacerating with pressure in the shoul- 
der-joint; lameness and lacerating in the wrist-joint; burning- 
stinging in the hip-joint ; stiffness of the hip-joint ; stiffness and 
immobility of the limbs ; tingling in the part. Pain as if bruised 
in the bones ; burning and lacerating pain in the left frontal emi- 
nence ; violent gnawing pain in the region of the frontal eminences ; 
lacerating and drawing below the malar bones ; lancinations from 
without inwards in the lumbar vertebrae, like stabs with a knife ; 
lacerating in the tibiae. 

Worse at night ; also when moving, from touching the parts but 
softly. 

Better while lying down. Right side. 

Bryonia alba. Stiffness of all the joints ; stitches in the joints 
when moving or touching them; shining red swellings, or pale col- 
orless swellings of the part ; swelling of the elbow-joint ; pain in 
the wrist-joint as if sprained ; tension in the ankle-joint, with hot, 
red, inflammatory swelling of the feet. Corrosive gnawing of the 
bones of the head ; tension and painful stiffness of the joints. 

Worse in the evening; also from motion, and from heat. 

Better from reposing, when still, and on getting warm in bed. 
Right side. 

Calcarea Carbon. Pain in the shoulder and elbow-joint, as 
after great fatigue ; pain as if from a sprain in the right wrist joint ; 
stitches in hip-joint when stooping ; stitches in the knee ; feeling 
as if something in the right wrist joint had been contused. 

Worse in morning and night ; also from cold, and pressure of 
the clothes. 



278 Surgical Diseases of the Joints. 

Better from warmth, on loosening the garments, and on drawing 
up the limbs. Right side. 

Calcarea acet. Cutting in the acetabulum when sitting. 

Calcarea phos. Pain in the joints with every storm ; exostosis. 

Cantharides. Lacerating in the joint affected ; swelling, heat, 
redness, or even gangrene of the part ; drawing pain in shoulder- 
joint ; boring in the knee, with contraction of the lower limbs. 

Worse in the morning; also every seven days. 

Better when lying down. Right side. 

Carbo veg. Bruised feeling in the joints ; paralytic weakness 
of the shoulder and whole arm ; pain as if from contusion in the 
elbow-joint ; drawing in the metacarpal bones ; lacerating in the 
wrists ; drawing pain in the hip-joint that extends down the thigh ; 
burning about the knee ; lameness of the knee-joint. Lacerating 
in the bones of the head ; burning in bones ; drawing pain in the 
upper and lower jaw; lacerating jerks in the right upper jaw; 
spasmodic pain in the lower jaw. 

Worse in forenoon ; also in the open air, from poultices and 
pressure. 

Better after lying down. 

Chamomilla. Bruised pain in all the joints, as if they were 
worn out ; cracking of the knee when moved ; sensation of numb- 
ness in the affected extremity. 

Worse at night ; also when lying down, and from touch. 

Better when rising. Left side. 

China Off. Pain in the joints as if bruised; stiffness of the 
joints ; pain with lameness or weakness of the affected part ; dart- 
ing lacerating pains, hot swelling of the right knee, with drawing, 
lacerating pains ; darting lacerating pains in the metatarsal and 
phalangeal joints, increased by contact, not changed by motion. 

Worse at night ; also from the slightest touch. 

Better in the room. Left side. 

Clematis. Arthritic nodosities in the finger joints; shooting, 
lacerating in the knee. 

Worse from the heat of the bed, and from washing. 

ColchiCUITI. Lacerating in the elbows, in the direction of the 
upper arm ; lacerations in finger-joints. Tearing pains in both 
muscles and joints. Pains wander from part to part. They feel 
as if in the periosteum, and are accompanied by a paralytic feel- 
ing, together with a loss of muscular power approximating paralysis. 



Special Therapeutics. 279 

The action of Colch. is more marked on the small joints than on 
the large. 

Worse in the evening and at night ; also from motion and contact. 

Better while reposing. Right side. 

ColOCynth. Flying pains in the shoulder ; stiffness of the knees ; 
darting pains in the ankles ; stitches in the knee-joints ; burning 
pain in the affected part. 

Worse in the afternoon and evening ; also when lying on pain- 
less side. 

Better when lying on painful side, and moving. Right side. 

Conilim mac. The shoulder feels as if pressed sore ; paralytic, 
drawing pain in the wrist-joint ; drawing pain in the hip-joint ; dull 
pain in the knee when stepping ; arthritic pain around the knee- 
joint ; pain as if from fatigue in the knee ; dull pain in the tarsus ; 
cracking in wrist-joint. Bones of the extremities feel as if in a 
tight band ; cancer in the middle of the long bones ; drawing pain 
in the temporal bones ; aching of the facial bones ; stitches in the 
small of the back, with drawing through the lumbar vertebrae 
when standing; periostitis, with throbbing and burning pain, as 
if from an ulceration. 

Worse in the morning and at night ; also when standing, lying 
down, and when lifting the affected part. 

Better from letting the affected limb hang down, from moving, 
and walking. Right side. 

Digitalis. Piercing pain in the joints; pale swellings ; dull sen- 
sation in elbow-joint ; stiffness in the joints 01 the lower limbs ; 
the knees feel as if greatly fatigued ; swelling of the knee with 
a stinging pain ; pain in the hip-joint ; grating nodosities. 
Worse after breakfast and dinner. 

Dulcamara. Corrosive gnawing in the outer side of the elbow; 
weariness of the knees. Painful stitches in the middle of the 
dorsal spine when breathing; boring in temples; painful weari- 
ness in tibia. 

Worse in the evening ; also when at rest, from cold air, and in 
wet weather. 

Better from moving about. Left side. 

Eupatorium. Painful soreness in both wrists, as if broken or 
dislocated : painful soreness in right parietal protuberance ; pain 
in the bones as if broken. 

Graphites. Stiffness in the joints of the arms and knees, with 



280 Surgical Diseases of the Joints. 

liability to become strained ; stitches in the elbow and shoulder 
joints; paralytic pressure in the elbow-joint; pain as if sprained 
in joint of thumb ; arthritic lacerating in hip-joint ; tension in 
the bends of the knees ; pain as if from bruises in knee. Pain in 
the periosteum of all the bones ; gnawing pain in the bones of the 
forearm ; drawing pain in the bones of the thigh ; the malleoli 
painful to the touch. 

Worse at night ; also from cold. 

Better from warmth. 

Guaiacum. Drawing pain in knee, terminating in a stitch. 
Dull ache in the left jaw ; drawing and lacerating along the right 
side of the vertebral column ; lancinating lacerations in the bor- 
ders of the scapulae ; painful drawing and lacerating in the arm. 

Worse in morning and forenoon ; also in the open air, and from 
contact. Left side. 

Hepar SUlph. Stitches in the joints; hip-joint feels sore and 
painful as if sprained when walking; pain as if from bruises in 
the knees. Bone diseases from abuse of Mercury. Nasal bones 
are painful to the touch ; contractive sensation in the nose ; sharp 
pressure and pain, as if from burns in the lumbar vertebrae ; pain 
as if from bruises in the humeri. 

Worse at night ; also from colds, when lying on painful side, 
from pressure, and on touching the parts. 

Better from warmth. 

lodium. Lancinating in joints ; rough, dry skin over the joint 
affected ; violent stitches in shoulder-joint, even when at rest ; 
tensive pain in finger-joints when bending them ; inflammatory 
swellings of the knee, with violent pains and suppuration ; drop- 
sical swelling of the knee. 

Worse in the evening and at night ; also when lying on the pain- 
ful side, from pressure, and from warmth. 

Better from cold, and after rising from the bed. Right side. 

Kali Carb. Stitches in the joints and tendons ; stiffness of the 
joints of the arm ; lacerating in elbow and wrist-joints ; painful 
lameness of the joints of the arm ; crampy lacerating in the hip- 
joint ; lacerating in knee-joints ; pain in hip-joint as if from a 
bruise; paralytic sensation in knee; spasmodic lacerating in ankle- 
joint ; frequent lacerating in the tarsal bones ; lacerating in the 
phalangeal joints of the toes. 

Worse in the morning ; also in cold air, and when lying on the 
side. 



Special Therapeutics, 281 

Better from warmth. 

Kreasote, Pains in the joint as if sore and ulcerated; as if 
bruised or contused ; frequent pains in the elbow-joint ; drawing 
pains in the fingers ; darting pain in and above the knee. 

Worse in the morning; also in the open air, and on moving. 

Better from warmth. Left side. 

Lachesis. Contraction and stiffness of the joints, with lacer- 
ating in the limbs ; lacerating pain in the elbow; pain in the wrist- 
joints as if they were sprained ; lacerating in the hip ; stinging, or 
lacerating in the knees. Throbbing in the bones in the neighbor- 
hood of the ear; drawing in the bones of the nose; drawing in the 
malar and jaw bones; lacerating in the jaw; pain in arm bones; 
lacerating in the bones of the legs. 

Worse in the evening; also in the open air, and from cold. 

Better from warmth ? Right side. 

Ledum pal. Lancinating pain in the joints ; painful hard tuber- 
cles and tophi in the region of the joint ; painful sticking in the 
shoulder-joint on lifting the arm ; pressure in both shoulder-joints, 
more violent during motion ; pressure in the elbow; laming, rheu- 
matic pain in hip-joint; pressure in the region of the hip-joint; 
weakness in the knee-joint, and lacerating pressure in those joints 
when walking; swelling with tensive and pricking pain in the knee 
when walking. 

Worse in the evening and at night ; also from heat and motion. 

LyCOpodium. Drawing and pressure in all the joints, more 
especially the knees; stiffness of the joints lacerating pain in 
shoulder and elbow-joints ; paralytic pain in shoulder-joints • 
bruised pain in shoulder-joints ; fingers stiff from arthritic nodosi- 
ties ; finger-joints swollen and inflamed ; rheumatic tension in the 
hips ; paralytic pain in the hip-joint ; pain as if from a sprain in 
the hip-joint; stiffness of the knee-joint; tension around the 
knee ; lacerating in the knees and ankles ; pain as if from a sprain 
in the knee-joint ; swelling of the knees ; swelling of the ankle. 
Bones are painful when touched ; lacerating in the malar bone and 
upper jaw; drawing in the jaws; drawing or lacerating at times 
in the lower jaw ; pain as if from bruises in the scapulae, shoulders 
and upper arm ; nightly bone pains. 

Worse in the evening ; also when lying down, when rising from 
a seat, and from the pressure of the clothes. 

Better on getting cold. Right side. 



282 Surgical Diseases of the Joints. 

Manganum. Drawing, lacerating stitches; soreness and cracks 
in the bends of the joints ; tensive pain in the arm and carpal 
joints ; darting pain above the knee. 

Worse at night; also on stooping, and to the touch. 

Better : The symptoms which appear in the room, disappear 
upon going into the open air ; and vice versa. Right side. 

MerClirillS. Arthritic pain and swelling of the joints; arthritic 
pain attended by very copious sweat, which does not afford any 
relief; sweat at every motion ; cracking in the shoulder and elbow- 
joints ; lacerating in the shoulder-joint, humerus and wrist-joint ; 
painful stiffness of the wrist-joint ; lacerating in the hip-joint ; the 
knee-joints are painful, and feel as if broken; lacerating in knee- 
joint. Bones ache under all circumstances, and no position affords 
relief; pain in the joints, almost uninterrupted, as if squeezed, 
broken, and sprained all at the same time ; abscess in the joints ; 
the whole of the skull is painful to the touch; lacerating pain in 
the bones of the head; exostosis on the head; swelling of the 
bones of the nose ; boring and drawing pain in the tibia. 

Worse at night; also from the heat of the bed. 

Better when at rest, and when lying down. 

Mezereum. The joints feel painful as if bruised ; drawing, with 
excessive weariness in the joints; hot dartings, and paralytic 
drawing pains; pain in shoulder-joint as if it would tear, with 
throbbing; tension in shoulder-joint; tensive lameness in the 
elbow-joint on raising the arm ; darting pain in the hip-joint down 
to the knee. Bone diseases from the abuse of Mercury, also from 
syphilis; inflammation of bones, with caries. (Periostitis of the 
tibia consequent upon an ulcer of the leg, the parts being covered 
with a brown, dry skin, and being surrounded with reddish-blue 
spots, with violent burning pains caused by the pressure of the 
fingers ; swollen periosteum, the violent pain preventing from tread- 
ing on the foot, and cramps in the calves of the legs. — (From 
Noack and Trincks). Ulcers of the bones, with morbid inter- 
stitial growth of the soft parts, even in the case of fistula; bone 
pains in the skull. 

Worse in the evening, and at night; also from contact and 
motion. 

Better when walking in the open air. 

Nitric acid. Pressure in the right shoulder; painful stiffness 
of the knees, feeling as if the bends of the knees were swollen. 



Special Therapeutics. 283 

Inflammation of the periosteum, and of the bones ; caries from 
syphilis, or the abuse of Mercury *; caries of the bones of the skull; 
the whole right side of the skull is painful ; aching of bones ; draw- 
ing and aching pain ; bones of the face are painful ; tearing in the 
malar bones. 

Worse in the evening, and at night; also on rising from the 
seat, and from touch. 

Better on getting warm ? 

NlIX mOSCh. Paroxysms of drawing in the arms, with frequent 
boring through the elbows; pain in the right knee as if sprained. 

Worse in the forenoon and evening; also from cold, in wet 
weather, and from lying on painful side. 

Better from warm air, in dry weather, and in the room. 

NlIX Vomica. Pains in the joints as if bruised; inflammation 
of joints, with burning- stinging; sensations in bends of knees as 
if they were too short ; arthritic inflammation and swelling of the 
knees. 

Worse in the morning: also from motion, and light touch. 

Better from strong pressure. Right side. 

Petroleum. Ulcerative pains in both sides of the head ; draw- 
ing and tension in the jaw below the ear ; drawing, with pressure 
in the bones ; paralytic drawing in left tibia and forearm, with 
pressure. 

Worse in the morning and evening. 

Better from warmth. 

Phosphorus. Pressure and drawing in the shoulder ; pain in 
the elbow-joint as if broken ; lacerating in the wrist-joint ; pain in 
the left hip-joint ; pain in hips as if sprained ; arthritic stiffness 
in the knees ; drawing pain from the knees to the feet. Beating 
and gnawing in the right parietal bone ; shining, painless, unin- 
flamed tumor on the forehead, with violent headache over the eyes ; 
tickling in the periosteum around the eyes ; sticking in the malar 
bone ; painful drawing and tearing in the lower jaw toward the 
chin; jerking in the lower jaw, almost like toothache; stitches in 
the right clavicle ; soreness of the clavicle, whether touched or not; 
pain in the os coccygis, as if ulcerated ; unceasing stitches in the 
spinal column; stitches in the lumbar vertebrae; feeling as if a 
plug had lodged in the left scapula; bruised pain in left humerus; 
gnawing pain in elbow, extending towards the shoulder ; painful 
pressure in the periosteum of the humerus and radius ; tearing 



284 Surgical Diseases of the Joints. 

and drawing in the elbow-joint; shocks and jerking in the tuber- 
osities of both arms ; pain as if bruised in the periosteum of the 
tibia, painful to touch. 

Worse in the evening, and at night ; also from motion. 

Better from rubbing, and after sleeping. 

Phosphoric acid. Bone pains from the abuse of Mercury j 
intense pain in the periosteum, as if scraped with a knife ; purulent 
discharge from the nose ; painful drawing in the dorsal vertebrae 
as if bruised; burning in the elbow-joint; nightly burning-lacer- 
ating in the tibia. 

Worse at night ; also from talking, and when at rest. 

Better from motion. 

Plumbum acet. Contractions in the joints ; stiffness of the 
knees, with swelling of the feet. 

Pulsatilla. Erratic, wandering pains, moving from one joint to 
another, with swelling and redness of the limbs ; pain as if bruised, 
or as if from sub-cutaneous inflammation on touching the part; 
continuous lacerating pain in the shoulder-joint ; bruised pain in 
elbow-joint; painful stiffness of the wrist-joint; lacerating pains 
in the knees, like jerks ; swelling of the knee, inflammatory and 
hot; (or painless?); swelling of knee, with stinging; lacerating 
pain in elbow-joint on attempting to move it. Curvature of the 
bones ; interstitial distention of the dorsal vertebrae nearest the 
neck ; drawing-lacerating pain in the bones of the forearm ; pain 
in the bones of the thigh as if bruised; tibia is painful when 
touched ; pain as if bruised in the tibia, especially when raising 
the leg; drawing in bones of leg. 

Worse in evening; also from warmth and motion. 

Better from cold. Right side. 

Rhododendron. Cramp-like drawing pain ; pains quickly gone; 
cedematous swelling of joints ; lacerating in the shoulder, or violent 
beating and drawing pain; pain in the hip as if sprained; white 
swelling of the knee ; cold uninflamed swelling of the right knee, 
with raging pain extending to the leg, in bed, and during rest ; 
digging-up, or drawing pain in the wrist-joint ; cedematous swell- 
ing of legs and feet. 

Worse in the morning ; also during rest, from cold, and wet. 

Better from motion, and warmth. 

Rhus tox. Sticking in the joints during rest; pains as if 
sprained ; lacerating and burning in the shoulder, with lameness 



Special Therapeutics. 285 

in the arm ; lacerating in the joints of all the ringers ; pain as if 
sprained in the joints of the lower extremities. Pressure with 
drawing in the periosteum, as if the bone were scraped; red, 
shining swelling, with stinging or sore pain when touched ; bones 
swollen ; drawing and lacerating in the eye-brows and malar bone ; 
pain in the articulation of the jaw as if bruised; painful bony 
swelling in the small of the back ; curvature of the dorsal verte- 
brae ; bony swelling on the arm, with burning and ichorous ulcers ; 
the skin covering bony tumors is red, inflamed, and covered with 
little blisters. (Feeling in the bones of the leg, as if they were 
split and spreading apart when stepping. G). 

Worse in the morning, and at night; also on beginning to move. 

Better from motion. Right side. 

Rllta grav. Pains in the joint, as after a bruise, fall, or contu- 
sion ; pain as if sprained, with stitches in the wrist-joint. Pains 
in the bones of the hips as if bruised; pains at all times in the 
bones of the wrist and dorsum of the hands, as if bruised, both 
during rest and motion ; burning and gnawing in the periosteum ; 
stitching, drawing pain, from the frontal to the temporal bone ; 
cramp-like lacerating in the malar bones, with stupefying pressure 
in the forehead ; a spot on the sternum is painful when touched ; 
pains in the lumbar vertebrae, as if they were bruised ; dull lacer- 
ating in the long bones of the arms; burning and corrosive pains 
in the bones of the feet during rest. 

Worse in the afternoon; also during rest, and in wet, cold 
weather. 

Better from motion. Left side. 

Sabina. Lancinations in the joints, with sensation as if they 
were swollen, accompanied with drawing stitches through the long 
bones ; paralytic pain in the joints, especially after any exertion ; 
lacerating in the finger joints ; painful drawing in the joints of the 
toes. Painful pressure in both upper arms near the elbow-joint; 
aching or burning pains in the swollen periosteum ; paralytic pain 
in the region of the malar bone ; aching in the region of the malar 
bone ; intermittent stitches in the clavicle ; lacerating pain, with 
pressure, in the metacarpus. 

Worse at night ? also from contact, and from the heat of the bed. 

Better from cold? Left side. 

Sarsaparilla. Lacerating in almost all the joints and limbs ; 
paralytic pain in shoulder-joint; paralytic weariness in elbow- 



286 Surgical Diseases of the Joints. 

joint ; pain as if sprained in wrist-joint ; lacerating in the knees ; 
swelling and stiffness of the knees with stitching pain ; paralytic 
and bruised feeling in hip-joint. 

Worse in afternoon ; also from cold. 

Better from warmth. Right side. 

Sepia. Rigidity of the joints of the arms and fingers, as if too 
short ; stitches in the wrist-joints on moving the hand ; stiffness 
of the elbows ; tensive pains in the metacarpal joints ; arthritic 
drawing in the finger-joints ; coxalgia, with lancinating pains ; 
cramp pain in the hip-joint; drawing pain in the knees ; also stiff- 
ness. Swelling above the temple ; aching pain in the malar and 
nasal bones ; cramp pain in the facial bones. 

Worse in the morning and evening ; also when stretching the 
limb, and when at rest. 

Better from violent exercise, and warmth. 

SHiC6a. Nightly sticking in all the joints ; stitches from the 
wrist-joint through the arm ; joints are painful when pressing on 
them ; painful feeling of stiffness in the knees ; weakness of the 
knees ; inflammatory swelling of the knee ; lacerating in the knees. 
Drawing pains in the bones ; gnawing pains in the bones of the 
nose; caries and swelling of the lower jaw; curvature and swell- 
ing of vertebrae ; bruised pain in scapulae ; is more or less useful 
in all cases of caries. 

Worse in the night ; also from cold, wet, and when sitting. 

Better from motion and warmth, and when wrapped up warmly. 
Right side. 

Staphisayria. Dull sticking pain in region of shoulder-joint ; 
violent aching pain in shoulder-joint ; paralytic drawing pain in 
phalangeal joints ; dull stitches in knee-joint near the patella ; hip 
disease. Mercurial bone diseases ; pains in bones, with debilitated 
feeling in joints ; swelling of the bones ; inflammatory pains in the 
malar bones ; boring stitch in the right tibia ; drawing, with pres- 
sure, in the outer part of the tibia. 

Worse, all times alike, except in the evening, when he ; s better 
on being touched. 

Better after breakfast. Right side. 

Sulphur. Erratic gout ; arthritic pains, with or without swell- 
ing; sticking pains in the joints, with stiffness; violent drawing 
and lacerating through the knees and tibia ; cracking in the joints, 
particularly in the knee and elbow ; drawing pain in the shoulder- 



Sp ecia I Therap etc tics. 287 

joint, and in the arms ; lacerating in the shoulder-joint ; lacerating 
pains in the wrist-joints ; stiff, red finger-joints, as if frozen; 
drawing pain in the left hip ; pain in the knee as if stiff; the bends 
of the knees are rigid ; inflammatory, thick, shining swelling of 
the knees ; dropsy of the knee-joints. Inflammation, swelling, 
and curvature of the bones ; pressure and burning in the malar 
bones ; painful swelling of the jaw. 

Worse in the evening, and at night ; also on waking, on getting 
warm in bed, from bodily exertion, when at rest, and from touch. 

Better from drawing up the limbs, from motion and heat. Left 
side. 

Thuja. Painful difficulty of moving either arm, as if it had no 
synovia ; throbbing in the elbow-joint, like pulsations ; pain in 
elbow and wrist-joints as if dashed to pieces and crumbling; 
lacerating in the wrist-joint ; dull tingling pain in the outer side 
of the knee ; painful pressure in the inner side of the knee. Boring 
pain in the region of malar bone, diminished by contact. 

Worse in the evening, and at night ; also from cold wet, and the 
heat of the bed. 

Better from warm wet. 

Veratrum. First the right, then the left hip-joint feels par- 
alytic; icy-coldness of the feet, and cramps through the tarsal 
joints. Seldom indicated in these diseases. 

Operations. 

For the relief of the various affections, we either resect or ampu- 
tate. In the treatment of scarcely any other class of diseases is 
the old adage so true that " amputation is the reproach of surgery." 
The difficulty lies, however, in the fact of our seldom seeing 
these cases in their incipiency, more rarely until they are fully 
developed. 

In anchylosis, forcible extension is much resorted to, but to me it 
seems, to say the least, a useless procedure, for an additional 
inflammation is set up, and if my notions are true the extension of an 
inflammation already existing will be of the same character, i. e., 
suppuration, adhesive, gangrenous, or cancerous, as the case 
may be, the result is apt to be an increase of immobility. I 
should say, in the partial form, trust to remedies ; in the complete, 



288 Surgical Diseases of the Bones. 

remove a wedge-shaped piece of bone, if the position of the limb 
is inconvenient, and give it the required position. 

Hip disease may require operation ; if so, resect. But as this is 
an important operation, my limits forbids its consideration. 

Enlarged bur see may be removed by dissection ; and Ganglions 
had best be ruptured by a sudden blow with some heavy object. 



SURGICAL DISEASES OF THE BONES. 

Periostitis, Osteitis, Caries, Hypertrophy, Rickets, Fra- 
gilitas ossium, tubercles, exostosis, osteo-sarcoma, 
Hydatids of Bone, Osteo-Aneurism, Fractures. 

Periostitis. 

This is an inflammation of the periosteum, and is generally 
described as being simple or complicated, acute, chronic, idio- 
pathic, or traumatic. I cannot subscribe to these divisions, inas- 
much as it does not seem possible that a disease can be local, or 
exist alone, without any other complications. It must depend 
upon some constitutional taint, such as scrofula, syphilis, or the 
abuse of mercury. I should prefer, then, to call the varieties 
traumatic, syphilitic, scorbutic, or medicinal. They may be 
either acute or chronic in any variety. The symptoms are swell- 
ing of the limb, sometimes, though not always, redness, puffiness 
and hardness of the part, tenderness on pressure, and usually on 
motion ; the swelling is circumscribed in a measure, though not 
always so. The symptoms in very many particulars closely re- 
semble rheumatism, but attention to the fact of the pain being 
deeper will be sure to prevent an error of diagnosis. 

Osteitis. 

This is an inflammation of the substance of the bone. Like 
periostitis, it may be acute or chronic, traumatic or cachectic. 
When acute, the bone is swollen and softened. In the chronic 
form the bone is enlarged, but very hard, like ivory. Sometimes 



Caries. 289 

there is considerable elongation of the bone, without any thicken- 
ing, so that one limb may be larger than the other by one or two 
inches ; this is most common in the chronic form. 

The symptoms of this disease are : an enlargement of the bone, 
aggravation of the symptoms in wet weather, or when the weather 
changes, pain, swelling, tenderness on pressure, and on motion, 
and some fever and redness of the skin in the acute form. This 
inflammation is the accompaniment of, or precedes or follows, all 
other diseases of the bone, caries, necrosis, suppuration, etc., hence 
the importance of a correct diagnosis, and prompt treatment, to 
prevent the development of something worse. One common re- 
sult of osteitis is suppuration of bone, or the formation of an abscess 
in some portion of it. It is not unfrequently seen following am- 
putation, and is then known as osteo-pyelitis. In this form, which 
also constitutes the acute variety, the medullary canal is the part 
primarily invaded, and the cancellated structure shows signs of in- 
flammation and increased vascularity. Often osteo-myelitis, or 
gangrene of bone, occurs, and is to be dreaded, among other 
reasons, from the fact that pyemia or phlebitis may be set up. 
The symptoms of suppuration of bone are sudden and deep- 
seated pain, swelling, tension, and oedema of the part ; the secre- 
tions of the stump are arrested, and the wound takes on a slough- 
ing character, with rigors. Chronic suppuration is of a circum- 
scribed form, and is the result of inflammation, terminating in 
abscess. Like the acute form, it is oftenest found in the heads of 
the long bones, and cancellated structure generally. Soon after 
the receipt of an injury, the bone is observed to be painful, 
swollen, and hard ; the skin does not change its color as a rule, 
though it sometimes assumes a red, glazed, and, cedematous ap- 
pearance. The pain may be lancinating and severe, or dull and 
aching, and is not apt to be steady, but may remit for even days 
at a time. However free from pain the patient may be during 
these remissions, there will be found one spot on the swollen bone 
that is painful to pressure. There can be no question, to my 
mind, but that a free and early evacuation of the pus by the 
application of the trephine, is the proper treatment to pursue. 

Caries. 

Formerly this was supposed to be a disease of the bone analo- 
gous to ulceration of the soft parts, but it is not so, at least in all 
19 



290 Surgical Diseases of the Bones, 

varieties. We have one variety, chiefly occurring in syphilitic 
cases, in which the disease as regards the line is superficial, only 
being denuded of periosteum, and this is the true ulceration of 
bone. The bone in caries becomes more vascular, softens, and 
finally becomes disintegrated. It usually manifests primarily in 
the centre of a bone, and is always well-established before any 
external sign is presented. The skin becoming involved last, we 
are often unable to form our diagnosis until the disease is fully 
established. After the limb has become inflamed, a swelling 
forms over the seat of the disease, ultimately forming an abscess, 
which opens, leaving a fistulous ulcer which will not heal. On 
introducing a probe into this fistula, we find the bone bare and 
rough, and its surface full of cavities and depressions, which, how- 
ever, break down readily under the pressure of the probe, and 
emit during this process a peculiar sound, likened to the crushing 
of sugar. When the shaft of the long bones is involved, there is 
some tendency to deformity of the limb, which must be combated 
by the use of splints, as in fracture, to resist the injurious con- 
traction of the muscles. 

Necrosis. 

This disease corresponds to gangrene of the soft parts, and, as 
Erichsen says, diners from caries " in the fact that caries may be 
regarded as the granular disintegration, or molecular death, of the 
osseous tissues, conjoined with suppuration of the surrounding 
healthy parts, while necrosis must be looked upon as death of the 
osseous tissue as a whole." Caries is, again, more frequently seen 
in the articular ends, or the interior of the bones, while necrosis 
oftener, indeed always, affects the compact portion. When some 
cachexia is not the predisposing cause, any injury which denudes 
the bone of its periosteum will produce it. Workers in Phospho- 
rus, as those who manufacture matches, are more subject to these 
diseases than others ; and from traumatic causes, whitlow or felon, 
or a disease which destroys the periosteum, are the most common. 
The local and general symptoms are nearly identical with those 
of caries, and vary mostly in intensity. When the large bones, as 
the thigh, are involved, the suppuration may be the cause of death 
if very extensive ; hence, if the sequestrum be fully formed, this 
would constitute a chief indication for its removal immediately. 



Fragilitas Osszum. 291 

In thro.wing off a central sequestra, nature provides for it by a 
thickening of the outer laminae, and the formation of apertures, 
called clocae, through which the dead tissue is extruded, 
and either carried away by the discharges, or else is in a more 
favorable position for removal by the surgeon. 

Hypertrophy. 

As a distinct disease, unconnected with other conditions of the 
bones, this is not very amenable to treatment. It is simply an 
increase in size, in every way — in length, thickness, density, and 
weight. It is the opposite condition of atrophy, in which the con- 
verse of all this is true. Some hypertrophy is due to an abnormal 
nutrition, or development : there are no new deposits, and no pre- 
ponderance of one element of healthy bone over another. 

Rickets. 

This is a softening of the bone, due to a deficiency of the 
earthy material, from which reasons the osseous structure is more 
properly cartilaginous, and not capable of sustaining the weight 
of the body. It is a disease peculiar to infancy, and those who 
are of a scrofulous tendency. 

Fragilitas Ossium. 

This is a disease directly opposite to the last mentioned, and 
is different, also in being peculiar to adults, particularly women. 
In this the bones, in addition to being easily bent, as easily break ; 
the slightest force being sufficient to produce this. In the 
early stages the disease resembles rheumatism so closely that it is 
almost impossible to tell them apart. The patient complains, in 
the first instance, of pains of a wandering character about the 
limbs and trunk; these assume usually a rheumatic character, 
though they have been observed to be of a much more severe, 
persistent, and intractable nature, than in any form of that affec- 
tion. The patient becomes debilitated, unfitted for exertion, and 
emaciated. Spontaneous fracture now occurs in some bones 
under the most trivial causes ; others become bent, and the whole 
body, consequently, greatly mis-shapen and distorted, occasion- 



29 2 Surgical Diseases of the Bones, 

ally in the most wonderful manner. The urine will be observed 
to present enormous quantities of phosphate of lime, diverted 
from the bones, and death eventually results from general ex- 
haustion. 

Tubercles of Bone. 

Tuberculous deposits seem to be as common in bone as in 
other parts of the human body. When found here they usually 
appear in the case of children, particularly those of a strumous 
cachexy, although adult age is not exempt. The cancellated 
structure, particularly the articulating ends of the long bones, are 
peculiarly liable to this invasion, and by their presence the most 
intractable bone-diseases are frequently caused. The spine, and 
the short bones of the tarsus and carpus are also liable, and here 
it usually leads to necrosis. When tubercle becomes decomposed, 
and forms an abscess, it is circumscribed or diffused according 
to circumstances. The abscess in finding an opening im- 
plicates the neighboring soft parts, and forms a sinus leading 
to the cavity of the bone, through which pus, of an unhealthy 
curdy character, mixed with the broken-down remains of the 
tubercle, is discharged. The diagnosis is even more obscure than 
in fragilitas, and is of just as little importance to us ; whether it 
be caries, necrosis, or tubercle, or all three, the symptoms guide 
us, and they alone. However, if you ever operate for either, re- 
move all suspicious spots. 

Exostosis. 

This means a tumor growing directly from the bone. The 
causes necessary for its production are remotely constitutional 
ones, such as struma or syphilis, and directly the reception of 
injury. Two varieties are recognized by pathologists — the one 
called hard or ivory> and the other the soft or cancellous. The 
diagnosis is sufficiently easy when the tumor is found on the out- 
side of the bones ; when on the inner surface of the skull, ribs, 
pelvis, or scapulae, they are not readily discovered ; save from 
their pressure effects, there are no symptoms of tumor, and these, 
even, are common to all tumors in situations where it is possible 
for them to compress organs. 



Fractures, 293 

Osteo-Sarcoma. 

This term is an unfortunate one, as generally applied, as it is 
customary to include under this title cystic tumors of various 
kinds growing from bones, whether they be benign or malignant 
and in consequence of this much confusion exists in surgical lit- 
erature. They may be single or multiple, and contain fluid, or be 
of solid formation. When the cysts are single, they are apt to 
contain solid matter, and when multilocular, are filled with fluid. 
The walls are thin and osseous, and cannot be mistaken for any- 
thing else, unless they are deep-seated. Those with fluid con- 
tents attain a larger size, and grow more rapidly than the others. 
Spina vcntosa is a term often used synonymously. 

Hydatids. 

The bones are sometimes found with cavities in their sub- 
stance, which are filled with these bodies. The signs of their 
presence are not to be distinguished from other diseases. 

Osteo-Aneurism. 

This is frequently spoken of as pulsating tumor of bone, and the 
term is preferable, as they are really not aneurismal. In structure 
and appearance they vary greatly — at times they are cancerous, 
and often mere vascular growths. They commence like other 
tumors of bone — feel elastic, grow slowly, without discoloration of 
the integument, and communicate to the hand a pulsation almost 
identical with that of aneurism. Two things must be guarded 
against in forming an opinion; do not confound it with true 
aneurism, and be sure that it is not some other tumor which has 
a pulsation derivable from some large neighboring artery. As 
these tumors are immovable, but little difficulty will ordinarily be 
experienced in determining their true character. 

There are other tumors of bone that need no special mention, 
such as cancer and sanguineous cyst. 

Fractures. 

Not being, in any sense of the word, a disease, we must dispose 
of the subject of fracture in a merely general sense. The term 



294 Surgical Diseases of the Bones. 

means, literally, a break, and in surgery, usually, a broken bone. 
In the case of the long bones, the direction of the fracture, so to 
speak, maybe transverse, or, as the French say, en rave — i.e., radish- 
like — oblique, or bec-de-flute (like tne mouth-piece of a flageolet) ; 
comminuted, impacted, or partial. In most of these varieties it can 
in nowise affect the treatment, as we will show, whether it be one 
or the other. In the impacted form, unless there is considerable 
deformity, we need do nothing, as it is already sufficiently " set." 
In the comminuted, the fragments, if too small to be placed in 
proper relation to each other, and the soft parts are not too ex- 
tensively injured, there are no special indications. If, on the 
contrary, the fragments are too small and numerous to offer any 
hope of reunion, they must be removed, and the case treated as 
one of ordinary resection. What was said of impacted fracture 
applies with equal force to the partial, or incomplete, variety. 
Bear in mind, however, that in the latter form our prognosis 
must be very cautious, as death frequently results after such in- 
juries, according to Malgaigne and others, without our being able 
to assign any reason for it. 

There may be a wound of the soft parts and integuments lead- 
ing down to the seat of fracture, or a protrusion of one or both 
of the extremities of the bone. In this case we have a grave 
complication, and call the variety a compound fracture. If a large 
blood-vessel or nervous trunk is also injured, whether there be an 
external wound or not, it is called a complicated fracture. These 
remarks apply in general to fracture of the long bones. 

In the flat or irregular bones, we have other terms, which suf- 
ficiently explain themselves — depressed, stellate, pe7'f orate, and ser- 
rated fractures. 

Treatment. — First be sure it is a fracture. The means to be 
used to determine this are not dwelt upon, as it is not properly in- 
cluded in our present plan. Having ascertained this, our next step 
is to reduce the fracture, keep the fragments in position, and facili- 
tate their union. The first procedure we leave untouched for similar 
reasons to those given above. To retain the fragments in posi- 
tion, position is the first thing to be considered. This position 
must be one that will completely relax any of the muscles that 
may tend to displace the fragments if not relaxed. To keep them 
in place, we may need splints, but surely very rarely, as they cause 
much uneasiness to the patient, cause jactitation, and, as frequent 
experience has taught many of us, do not always preserve the 



Special Therapeutics. 295 

position of the fragments. Wherever it can be done, the following 
procedure is one I adopt : Place the limb in such a position that 
the muscles which might keep the fragments asunder are com- 
pletely relaxed. Apply counter-extension in the usual way, by 
means of long strips of adhesive plaster attach a weight to the 
opposite extremity, and support the limb with bags of bran or 
sand, or pack it in loose sand. For the first twenty-four or 
forty-eight hours give Aeon, about once in two or three hours. 
After this time administer a dose of Symphytum, not lower than 
the 30th, once or twice a day. When consolidation has fairly 
begun, apply a plaster-of-Paris dressing, and allow the patient to 
move about on crutches. In the case of compound fracture, the 
method is but little modified. The extension and counter-exten- 
sion is made as usual, but Calendula will be required to heal the 
wound. When this is done, proceed as in a simple fracture. 

Occasionally, after we have done all that seems called for, the 
fragment will not unite. The treatment depends upon the cause. 
Should there be a tenden, or any foreign substance, interposed 
between the fragments, it must be removed. Should it be from 
inefficient reparative power, the fault is to be corrected by proper 
medicinal treatment, and not by any of the popular methods, such 
as exsection, ivory pegs, etc. Such a complication can but rarely 
occur under homoeopathic treatment, unless in the case of the 
very aged. From the great variety of symptoms that have to be 
considered in such cases, it is next to impossible to point out in 
this place any line of treatment. Suffice it to say, should Symphy- 
tum fail, recourse may be had to Calc. c, Cale. phos., Sil., or 
Sulph., among the more prominently indicated remedies. 

More special indications for the selection of the remedies in 
these diseases has been placed under Diseases of the Joints to save 
space, and inasmuch as the diseases of bones and joints are so 
intimately associated; also see Ulcers and Tumors. The brief 
" index " following will suffice for this place : — 
Bones of the Head : Mere., Petrol., Phos., Sabin., Sil. ; Aeon. 
Bell., Cale., Car bo v., Hep. s., Lye., Mezer, Nit. ac., Phos. 
ac., Puis., Sep., Sulph., Thuja. 

Face : Aur. m.. Nit. ac.; Con., Ars. 

Arm : Asa/., Rhus, Staph ; Arn., Pry., Lye., Merc., Me- 
zer, Phos., Puis., Ruta, Sil., Sulph., Thuja. 
Bones of the Legs: Lye., Merc., Phos., Puis., Ruta, Sil., Staph.; 
Am., Calc, Con., Hep., Nit. ac., Phos. ac, Rhus, Sep. Sulph. 



296 Surgical Diseases of the Bones. 

Mercurial Bone Diseases : Aur., Hep., Nit. acj Asa/, Lack., 

Lye, Mezer, Phos. ac, Puis., SiL, Staph., Sulph. 
Scorbutic : Ars., Baryta, Calc, Graph., Hep., Lye, Phos., 

Puis., Sep., SiL, Sulph. 
Syphilitic : Con., Merc, Nit. ac, Sulph., Thuja j Ars. Aur. 

Bell., Bry., Carbo v., Lach., Lye., Mezer, Phos., Rhus, Sil. 
Traumatic : Am., Con., Ruta ; Aeon., Ars., Bry., Rhus, Sil. 
Idiopathic : Aeon., Bell., Bry., Carbo v., Dulc., Eupat., Guaj., 

Hep., Lach., Lye, Merc, Petrol., Phos. ac, Rhus, Sabin., 

Sep., Staph., Thuja ; Am., Ars., Asa/., Aur., Calc, Con., 

Graph., Merc, Nit. ac, Phos., Puis., Ruta, Sil., Sulph. 
Periostitis : Aeon., Ars., Aur., Bell., Bry., Calc, Con., Eupat., 

Graph., Hep., Lye, Merc, Mez., Nit. ac, Phos., Phos. ac, 

Puis., Rhus, Ruta, Sep., Sil., Staph., Sulph. 
Osteitis : Aeon., Ars., Asa/., Aur., Bell., Bry., Calc, Carbo v., 

Col., Dulc, Eupat., Graph., Hep., Lach., Lye, Merc, Mez. 

Nit. ac, Phos., Puis., Rhus, Ruta, Sep., Sil., Staph., Sulph. 
Suppuration of Bone: Hep., Merc, Sil; Ars., Calc, Lye, 

Nit. ac, Sulph. 
Caries : Am., Ars., Aur., Baryta, Calc, Hep., Merc, Sabin. 

Sil., Sulph. 
Necrosis : Aeon., Aur., Bell., Bry., Calc Mezer, Nit. ac, Phos., 

Ruta g., Sil., Sulph. 
Hypertrophy : Asa/, Am., Aur., Baryta, Calc, Con., Merc 

Nit. ac, Phos., Ruta, SiL, Thuja. 
Rickets : Asa/., Ars., Baryta, Bell., Calc, Lye, Merc, Mez., 

Nit. ac, Petrol., Phos., Phos. ac, Rhus, SiL, Staph., Sulph. 
Fragilitas : Asa/., Calc, Dulc, Lye, SiL 

Exostosis : Asa/, Aur., Calc, Dulc, Guaj., Lye, Mere, Me- 
zer., Phos , Phos. ac, Rhus, Ruta, Sabin., SiL, Staph., Sulph. 
Osteo-Sarcoma : Aeon., Am., Ars., Asa/, Aur., Baryta, Bell., 

Bry., Calc, Con., Dulc, Eupat., Graph., Hep., Lach., Lye, 

Mez., Mere, Nit.ac, Phos., Phos. ac, Rhus, Ruta, SiL, Staph., 

Sulph. 
Osteo- Aneurism : Aeon? Am? Ars? Con? Dulc? Hep? Merc? 
The operations for the treatment of these various diseases are 
generally those of excision. When there is a choice between 
amputation and resection, resect, by all means. In resection we 
look for a more certain preservation of life, and an absence, total 
or partial, of deformity. The operation is too well understood 
to need detailing here. 



In -Growing Toe Nails, 297 



SURGICAL DISEASES OF THE NAILS. 

ONYCHIA, IN-GROWING TOE NAIL. 

Onychia. 

The nails are infrequently diseased, and usually in one of three 
ways ; the nail alone is affected ; the matrix alone ; or both the 
nail and the matrix. In the case of elderly people, or those of a 
broken-down constitution, the nails often become dry, scaly, enor- 
mously thickened, of a greenish or gray color, and a rough irregu- 
lar appearance. The most common disease of the nails is Onychia^ 
which is due to an inflammation of the matrix. It may be simple 
or specific. 

Simple Onychia is characterized by redness, heat and swelling, 
set up usually on one side of the nail, in the angle of the tissue 
in which it is implanted. There is no discharge of pus, and the 
nail gradually loosens, becomes dark-colored, shrivelled, and at 
last is completely detached. A new nail soon makes its appear- 
ance, but is liable to be badly shaped. In the simplest form of 
the disease, Am., Silic, or Sulph., are probably the remedies most 
frequently indicated. When occurring traumatically, in the 
absence of specific taint, Am. is the remedy. 

Specific Onychia is also known as "malignant." It is produced 
by injury inflicted on a finger while the system is contaminated by 
syphilis, scrofula, or cancer poison. In this form there is a forma- 
tion of pus, ulceration at the sides of the nail, and inflammation 
with a dark color of the skin. The nail is finally destroyed, and 
the new one imperfectly developed. The treatment of this form 
will but seldom be called for except in connection with the general 
disease ; then, of course, the remedy that cures the patient cures 
the nail. 

In-Growing Toe Nail. 

This is caused by wearing badly shaped shoes, which crowd the 
toes together, or from cutting the nail too square, leaving a sharp 
corner which is a constant irritation to the neighboring soft parts. 



298 Surgical Diseases of the Nails. 

From long-continued pressure from this sharp corner, an ulcer is 
at last formed, which becomes filled with immense granulations, 
hiding in many cases, the whole nail, and secreting an offensive 
pus. The pain is usually considerable, and prevents walking 
when fully developed. 

Of course all attempts to cure this ulcer as long as the cause 
which first produced it remains, must prove futile. The treatment 
must be mainly local for obvious reasons. In the first place, when 
the granulations are very large, they must be removed. Any 
strong astringent will do this temporarily. Next, the corner of 
the nail must be cut off, and its direction altered so that it will 
grow over the soft parts in place of into them. This is best effected 
by removing a very thin shaving from the corner of the nail every 
day. By drawing the edge of a sharp knife lightly from the root 
to the angle of the nail every day, (only once a day,) and only 
once at one operation, a thin shaving is easily removed. In a 
short time this corner will turn up. The ulcer must be treated as 
other ulcers, but in most cases Calendula will be found sufficient. 
Should it fail consult the chapter on " Ulcers." The ulcer cured, 
and. the direction of the nail changed, a repetition of the trouble 
must be guarded against by altering the shape of the boot. 

Should, however, all these measures fail, the only resource is 
the removal of the whole nail, and by properly constructed wax 
moulds favor the development of a perfect new one. 



Varix. 299 



SURGICAL DISEASES OF THE BLOOD- 
VESSELS. 

PHLEBITIS, VARICES, PYEMIA, ANEURISMS, ANEUR- 
ISM BY ANASTOMOSIS, ARTERITIS, FATTY DE- 
GENERATION OF THE ARTERIES, CALCIFICATION, 
NEVUS, WOUNDS. 

Phlebitis. 

The veins are more predisposed to inflammatory affections than 
the arteries, and particularly is this the case in persons of enfee- 
bled constitutions ; prominent among the causes are wounds, con- 
tusions, or the presence of a ligature when the vein is designedly 
tied, or is included in the ligature embracing the artery. Under 
some circumstances it is an exceedingly fatal condition, and in all 
cases is a disease of much gravity, demanding the most careful 
treatment. The pathology may be summed up as follows : the 
vein becoming inflamed from some cause, thickens at the point at 
which the injury is inflicted ; the outer coat particularly so. This 
inflammation is followed by an effusion of lymph from the internal 
coat of the vessel, producing an occlusion more or less complete, 
owing to the lymph organizing, and the existence of coagulated 
blood, " forming a solid mass." The next feature is the formation 
of pus, "not" says Erichsen, "produced by the transformation of 
the contained blood, but by effusion from the coats of the vessel" Any 
vein, or any portion of a vein, is liable to become thus affected, 
and the disease may invade it to any extent. 

Three varieties or stages are recognized by modern pathologists, 
1st — Adhesive phlebitis; 2nd — Suppurative, and 3rd — Diffusive 

Varix. 

Of all diseases of the circulatory apparatus, this of varix, or 
varicose veins, is by far the most common. It consists in a weak- 
ening of the walls of the vein, followed by an irregular distension, 



300 Surgical Diseases of the Blood- Vessels. 

in some places in the form of sacs or pouches, while in others it 
seems to be a uniform enlargement in calibre. Anything which 
would weaken or lacerate one of the coats of the veins, will pro- 
duce this condition. Long standing, or constriction exercised on 
a vein, as in the case of tight garters, are among the more frequent 
causes. In this disease the valves seem to be obliterated and the 
blood collects in these pouches, and may in time become coagu- 
lated. The lower extremities, and the veins of the rectum and 
vicinity, seem to be the most obnoxious to this condition. Those 
of the scrotum are often so, and it is then known as varicocele. The 
part so affected is found to be cedematous, and more or less numb, 
sometimes an almost complete loss of power is noticed. There is 
seldom any pain, unless it be from pressure exerted on some nerve. 
These pouches or bunches sometimes open spontaneously, though 
very rarely ; and are sometimes broken by accident, when a very- 
intractable ulcer results, which, under some methods of treatment, 
is very properly considered incurable. Phlebitis may occur as a 
concomitant, though in a bad form it is very rare. Hemorrhoids, 
are, in my opinion, a true varix,.and nothing else. The superficial 
veins are the oftenest affected in this manner, and may attain a 
great size. 

Pyaemia. 

Pyaemia, is a supposed admixture of pus with the blood. It has 
also been called "purulent infiltration," and is a very serious, 
often fatal disease. Erichsen says it has never occurred idio- 
pathically, but is either subsequent to a wound that has been 
inflicted upon a person of a cachectic, readily suppurating consti- 
tution, or it is seen allied with the lowest and worst forms of 
erysipelas. " Pyaemia is characterized especially by two series of 
phenomena : The first is a great depression of the powers of the 
system ; the second, the formation of abscesses in various parts of 
the body. The symptoms are as follows : The patient is seized 
with rigors, usually of a very severe and continuous character, but 
occasionally short and transient, sometimes occurring irregularly ? 
at others repeated almost periodically, twice or thrice in the twenty- 
four hours, for some days in succession ; in some cases these rig- 
ors are not attended by any sensation of cold, but in others they 
are, and then alternating with much febrile disturbance, resemble 
very closely an ague fit ; any open wound that may exist at this 



Wounds of Blood- Vessels. 301 

time usually becomes foul, sloughy, and ceases to secrete pus, 
though I have seen healthy granulations continue throughout the 
disease. The skin is hot, and has a burning pungent feel, the 
breath has a peculiar sweetish, saccharine, or fermentative smell 
that is commonly noticed in all febrile diseases of a low type ; this 
odor of the breath, and indeed of the body generally, often occurs 
early in the disease, and must then be taken as a very unfavorable 
sign. The secretions are arrested, the pulse is quick and feeble, 
the face is usually pale, with a very anxious drawn look, but some- 
times flushed, and the eyes bright ; there is hebetude and dullness 
of the mind, with slight nocturnal delirium, but perfect conscious- 
ness on being spoken to ; about this period, patches of an erratic 
erysipelas frequently make their appearance on the surface, and 
the skin assumes a dull, sallow, and earthy, or a bright yellow 
icteric tint, which may extend even to the conjunctiva. The symp- 
toms now indicate an extreme depression of the vital powers, the 
pulse becoming small and fluttering, the tongue brown, with sordes 
about the teeth, and low delirium ; usually from the sixth to the 
tenth day, but sometimes earlier, diffusive suppuration begins to 
take place in different tissues, joints and organs. This may occur 
in the viscera without occasioning any material pain ; if seated in 
the cellular tissue, or in the substance of muscles, there is much 
doughy swelling with some redness ; if in the joints, the swelling 
is often considerable, the pain usually intense, and of a very super- 
ficial or cutaneous character, the patient screaming loud with the 
agony he suffers." 

In addition to the formation of pus in nearly every organ and 
part of the body, the blood is found loaded with cells, that are 
without doubt pus cells. It is a terrible disease, and the prognosis 
may always be unfavorable. 

Wounds of Blood- Vessels. 

Wounds of blood-vessels, including the procedure for tying 
them, or otherwise arresting the flow of blood, form a very import- 
ant chapter in surgery. Veins, when wounded, are not usually 
attended with fatal results, unless it should be some large and 
important trunk. Pressure in nearly every instance will be suffi- 
cient to effect a cure. Ligation, as in the case of arteries, would 
be easily done, but the results are doubtful, and may lead to 



2,02 Surgical Diseases of the Blood- Vessels. 

mortifying and fatal consequences. I would advise the acupres- 
sure plan of Sims. He uses an ordinary hair-lip pin, with a large 
head; this he passes through the skin, under the vessel, and 
brings it out on the other side through the skin. For vessels of a 
little smaller calibre, the placing of a soft compress over the vein, 
is the best plan. Torsion or twisting the ends of the vessel may 
be resorted to. When either of these methods fail, styptics had 
best be resorted to. Of these I know of none so permanent in its 
effect as Erigeron can.; a piece of lint saturated with the tincture 
and applied to the bleeding vessel, will in many cases arrest the 
bleeding instantly. When the effect does not seem to be strong 
enough, others may be tried, as the Per-chloride of iron, which is a 
powerful styptic, but is not long-lasting as compared to Erigeron. 

Wounds of arteries are a very different affair. Here the 
treatment must be prompt, and the artery must be closed. 
This may be by ligation, by the use of the acupressure needle, 
or by torsion, i. e., twisting the end of the vessel till the canal 
is completely obliterated. After the operation, give for one or 
two days, two doses daily of Aeon. 200; if the wound has been 
handled much, use Arnica 200 in place of Aeon. Afterwards use 
the Staphisagria lotion. If a large vessel, the main one of a 
limb, has been tied, keep the part warm, the patient in the recum- 
bent position, with the limb carefully laid on soft pillows. After 
operating on any vessel, large or small, keep the patient quiet. 

Treatment. — In determining the course to be pursued in the 
treatment of phlebitis, the character of inflammation — whether 
traumatic or idiopathic — must be taken into consideration, and, if 
it be referable to the former, the character of the injury. Before 
giving the names of remedies that are recommended, let me borrow 
from Erichsen something of the symptoms usually present. Adhe- 
sive, and consequently suppurative, phlebitis, commonly has a 
traumatic origin, and is generally ushered in by a hard, knotty, 
and painful swelling of the vein, " the knots constituting distinct 
enlargements opposite the valves." If the vessel be a superficial 
one, the color changes to a reddish-purple, and the limb becomes 
stiff, to a certain extent. There is not, usually, much pain, but a 
tenderness all along the course of the vessel.. One of the earliest, 
and in the case of deep-seated veins, the most certain indication 
of this disease is an oedematous condition of the part, which 
becomes hard and tense, pitting readily on pressure. In other 
cases the limb suddenly swells up without any oedema being 



Special Therapeutics. 303 

present. As the inflammation subsides, these symptoms disappear, 
unless suppuration intervenes, when they do not undergo any, or 
but little change. The most common termination, unaided by 
medicine, is the perforation of the vein, and the formation of an 
abscess; more particularly is this the case in the suppurative 
stage. This abscess must be opened at once, or pyaemia may 
result from this cause alone. The plug of lymph and blood may 
give way, or in its turn be perforated, and pysemia then be produced. 

In diffuse phlebitis, the symptoms are very similar to those 
already noticed, only the general symptoms are much more severe. 
Later the fever assumes more of a typhus character, sordes collect 
on the teeth, the tongue is brown and dry, delirium, vomiting, 
" diarrhoea, and death." " These (later) symptoms are indeed due 
to the formation of pus in the vein, its admixture with the blood, 
and consequent poisoning of the system." The prospects are not 
very favorable, but much may be done with our remedies. 

Of pyemia, mild cases may be as effectually treated as scrofula 
or abscess ; but the severe ones certainly seem hopeless. 

Varix, we homceopathists consider perfectly amenable to treat- 
ment by use of medicines administered internally; but an external 
application which (when they are strictly medicinal) is the same 
thing as the internal remedy, is not mal-apropos. The full and 
distended vessels demand as a primary indication, that they shall 
have some additional support to that which the integument or the 
walls of the veins afford. This is best secured by the use of an 
elastic band, or stocking, and when this is not attainable, judicious 
bandaging. It will not do to neglect this by any means. 

The remedies to be consulted in all their detail, local and con- 
stitutional, for these conditions, are as follows : 

Acetic ac, Aeon., Aloes, Ambra g., Ant. c, Apis m., Am., Ars., 
Asa/., Aur., Baryta, Borax, Bell., Bry., Cactus c, Calc, Carbo v., 
Caust,, Cham., Chin., Coloc, Con., Digit., Ferr., Graph., Guaj., 
Hama., Hep. s., Hyos., Ign., Iod., Kali c, Kreos., Lach., Lach. v., 
Lauro., Led., Lye, Mang., Merc, Mur. ac, Nat. m., Nit. ac, Nux 
vom., Phos., Plat., Puis., Rhus, Ruta,- Sep., Spig., Staph., Sulph., 
Tart, em., Thuja, Verat., Zinc. 

The index may be arranged as follows : 
Phlebitis : from Contusion. — Am., Con., Hep. 

from Varices. — Ham., Chin., Puis., Merc. 

from Injury. — Aeon., Am., Hep., Rhus. 



304 Surgical Diseases of the Blood- Vessels. 

Phlebitis: with OEdema. — Ars., Chin., Merc, Puis., Rhus, Apis. 

with Suppuration. — Hep., Merc.; Apis, Am., Con. 

with Typhoid Symptoms. — Ac. mur., Apis. 

with Vomiting. — Ars., Puis., Verat. 

Pyemia : Am., Asa/., Aur., Baryta, Bell., Bry., Cak., Car bo v., 
Cham., Con., Graph., Hep., Hyos., Iod., Kali c, Lauro., Led., 
Lye, Mang., Merc, Nit. ac, Nux v., Phos., Puis., Rhus, Ruta 
g., Sep., Sil., Staph., Sulph., Tart, em., 
Varix: Aeon., Aloes, Amb. g., Ant. c, Am., Ars., Bell., Calc. c, 
Carbo v., Caust., Chin., Coloc, Ferr., Graph., Hamam., Hep. s., 
Ign., Kreos., Lach., Lye, Nat. m., Nux v., Plat., Puis., Sep., 
Spig., Sulph., Zinc. 

Aconite nap. Vertigo when rising, with nausea, vanishing of 
sight, and bleeding of the nose ; face is yellow, or red and pale 
alternately ; trembling and stammering speech ; aversion to food ; 
burning, unquenchable thirst; coldness of the feet up to the 
ankles; sudden, great sinking of strength; burning in internal 
parts; painful sensitiveness of the body to contact; he does not 
wish to be touched. 

Worse at night ; also when lying on the left side, when rising, 
in a warm room, and from the heat of the bed. 

Better in the open air, and when sitting still. Left side. 

Aloes SOC. Giddiness, with anxiety when moving; lameness 
in all the limbs ; cold hands with warm feet ; sensation of weak- 
ness in the joints of the hands and feet. 

Worse in the afternoon ; also from standing, and from motion. 

Better from cold water. 

Ambra gris. Great restlessness ; flushes of heat to the face ; 
entire thirstlessness ; sensation of coldness in the abdomen on 
one side ; numbness of the whole body in the morning ; weakness 
in the morning, and at night when awaking; spasms and twitches 
in the muscular parts ; sleep disturbed by coldness of the body 
and coldness of the limbs. 

Worse in the evening; also while sleeping, on awaking, and 
when lying in a warm place. 

Better when lying on the painful part or side, and when walking 
slowly in the open air. Either side. 

Antimon. crud. Giddiness with nausea, or bleeding at the nose; 
sad countenance; thirst at night; rheumatic pains in the legs or 



Special r _ Therapeutics. 305 

arms; painful stiffness of the knee; very sleepy during the day, 
especially in the forenoon. 

Worse at night ; also in the heat of the sun. 

Better during rest, or in the open air. Left side. 

Apis mel. Giddiness when sitting, standing, lying, or when 
closing the eyes, with nausea and headache; burning, stinging 
heat in the face, with purple color ; thirstlessness ; cold legs, with 
cedematous swelling, as well as of the feet and ankles ; great 
debility, as if he had worked hard ; great sensitiveness to touch 
and to pressure. 

Worse in the morning, evening, and at night ; also from heat. 

Better from cold water. Left side. 

Arnica mon. Giddiness, with nausea when moving or rising ; 
sunken, pale face ; redness of one cheek ; vomiting of dark, clotted 
blood ; tingling in the legs ; sensation of soreness in the legs ; 
over-sensitiveness of the whole body ; sleepiness, with inability to 
sleep during the day; drowsiness with delirium. 

Worse in the morning, at night, and in the evening; also on 
moving, from cold, and on being touched. 

Better from warmth. Left side. 

Arsenicum alb. Restlessness; color of the face pale, or earthy, 
or yellowish, with blue rings around the eyes ; distorted features ; 
death-like countenance; violent, unquenchable, burning thirst, 
with frequent drinking, but of little at a time ; varix, with hard, 
burning, shining swelling of the feet ; sudden sinking of strength ; 
fainting, with weakness, and scarcely perceptible pulse. 

Worse at night ; also from cold, when lying on the affected side, 
and when lying with the head low. 

Better in the open air. Left side. 

Asafetida. Sense of rigor ; twitching and jerking in the mus- 
cles ; much inclined to sleep. 

Worse in the afternoon, and in the evening; also when sitting. 

Better in the open air. Left side. 

Alirum met. Sensation as if a current of air were passing 
through the head if it be not kept warm ; bloated, shining face ; 
immoderate thirst; over-sensitiveness to all pain, and to the cold 
air; great ebullitions, with congestions to the head and chest, and 
palpitation of the heart. 

Worse in the morning ; also from cold, and while reposing. 

Better from moving, and on getting warm. Right side. 
20 



306 Surgical Diseases of the Blood- Vessels. 

Baryta C. Dark redness of the face, with congestions ; feeling 
as if the face were covered by spider-webs ; heaviness of the body ; 
sleepiness day and night. 

Worse at night ; also when sitting, and when lying on the painful 
side. 

Better in the open air. Left side. 

Belladonna. Vertigo, with stupefaction, vanishing of sight, and 
great debility ; purple, red, hot face, or yellow color of the face ; 
face pale, with distorted, anxious countenance ; alternate redness 
and paleness of the face; excessive burning thirst, with con- 
stant desire to drink ; drinks hastily ; over-excitability of all the 
senses. 

Worse in the afternoon, and at night ; also on moving, and 
pain on touching the parts, even softly. 

Better while lying down. Right side. 

Bryonia alba. Unconsciousness ; giddiness, with sensation 
of looseness in the brain when stooping, and when raising up 
the head ; yellow paleness of the face ; hot, bloated, red face ; 
does not drink often, but much at a time ; swelling of the lower 
extremities, with redness and pain on motion. 

Worse in the evening; also from motion. 

Better when sitting, and on getting warm in bed. Right side. 

Calcarea Carb. Fullness and heaviness in the head ; internal 
and external sensation of coldness of one side of the head, as 
if a piece of ice were lying there, with pale and puffed face ; con- 
tinued and violent thirst for cold drinks ; varices on genitals of 
women, the labiae particularly ; coldness and deadness of the 
feet ; heaviness and stiffness of the legs ; great weakness and 
debility from talking ; tongue dry ; very sensitive to cold air. 

Worse in the morning, and evening ; also from cold and wet, 
and on awaking. 

Better from warmth. Right side. 

CarbO vegetab. Periodical weakness of the memory ; when 
moving the head, giddiness ; greenish color, or great paleness of 
the face ; tongue coated white, or yellow-brown ; excessive thirst ; 
varices on the female genitals ; heaviness in the lower extremi- 
ties ; the legs go to sleep ; numbness in the limbs ; burning 
pains ; great debility and weakness as soon as he makes the least 
exertion. 

Worse in the forenoon, and at noon ; also in the open air, and 
from pressure. 



Special Therapeutics. 307 

Better after lying down. Either side. 

CaustlCUm. Giddiness, with sensation of weakness in the 
head ; yellowness of the face ; semi-lateral paralysis of the face ; 
dry tongue ; paralysis of the tongue ; distortion of the tongue and 
mouth when talking ; violent thirst for cold drinks ; marbled skin 
on the legs ; swelling of the feet ; cold feet ; paralytic, trembling 
weakness of the limbs. 

Worse in the evening ; also in the open air. 

Better in bed, and from heat. Right side. 

Chamomilla. Hot, clammy perspiration on the scalp and fore- 
head ; bloated face ; redness and burning heat of the face, par- 
ticularly of one cheek, while the other is pale ; tongue dry, red 
and cracked ; or thick yellow or white coating on the tongue ; 
convulsive movements of the tongue ; thirst for cold water ; burn- 
ing in the soles of the feet ; sensation of numbness of the toes, 
over-sensitiveness of the nerves and senses. 

Worse at night ; also from cold, and when lying down. 

Better on rising. Left side. 

China Off. Nervous irritation, with slowness of ideas ; face 
pale and sunken, with pointed nose, and eyes sunken, with a blue 
margin ; pale, sickly appearance, as after excesses ; bloated, red 
face ; black coating of the teeth ; tongue is coated white or yellow; 
thick, dirty coating of the tongue ; blackish, parched tongue ; no 
desire for eating or drinking ; sometimes, violent thirst for cold 
water (or wine) ; drinking often, but little at a time ; icy-coldness 
of one hand, while the other is warm ; swelling of the feet ; un- 
easiness in the legs, obliging him to curve and draw them up ; 
over-sensitiveness of the nerves ; numbness of the parts on which 
one lies ; veins are much enlarged. 

Worse at night ; on touching the parts, after drinking, (and on 
motion ?). 

Better in the room. Left side. 

ColOCynth. Aversion to talk ; disinclined to answer questions; 
face pale and relaxed, with sunken eyes ; dark redness of the 
face ; swelling of the face, with redness and heat of one cheek ; 
burning at the tip of the tongue ; tongue coated white or yellow ; 
intense thirst ; sensation of coldness in the knees ; the feet go to 
sleep — first one, and then the other ; swelling of the feet ; faint- 
ness, with coldness of the extremities ; burning pains. 



308 Surgical Diseases of the Blood- Vessels. 

Worse in the afternoon and evening ; also while lying down in 
bed, or when lying on the painless side. 

Better from motion, and lying on the painless side. Right 
side. 

Conium mac. Giddiness when looking around ; heat in the 
face ; stiff, swollen, painful, and dry tongue ; sensation of debility 
in the morning in bed ; sudden loss of strength while walking. 

Worse in the morning, and at night ; also while standing, or 
lying down. 

Better when the affected limb is hanging down, and from motion. 
Right side. 

Ferr. met. Sickness at the stomach when walking, with sensa- 
tion as if the head would constantly incline to the right side ; 
congestion of blood to the head, with pulsation and hammering ; 
heat and redness of the face, with enlarged veins, and sensitive- 
ness of the head to the touch; earthy, jaundiced color of the 
face, or pale and bloated face, with red spots ; fiery red face, with 
enlarged veins ; swelling of the hands and feet ; with numbness 
of the thighs ; great emaciation ; restlessness in the limbs. 

Worse in the morning ; also when at rest, more especially when 
sitting still. 

Better from slow exercise. Left side. 

Graphites. Pain in the head, as if it were numb and pithy ; 
pale yellow color of the face ; flushes of heat in the face ; con- 
tinued feeling as of a cobweb on the face ; tongue much coated, 
with bitter taste in the mouth ; numbness and stiffness of the 
thighs and toes ; coldness of the feet in the evening when in bed ; 
great emaciation; the limbs go to sleep readily; pulsation 
through the whole body whenever he moves. 

Worse at night ; also from cold. 

Better from warmth. Either side. 

Hamamelis Virg. This has proved a very useful remedy to 
me in many cases of varix, and I am sorry that I can say no 
more of it than has already been said in other places (Vari- 
cocele, Hemorrhoids). I have used the first or third attenua- 
tions, and the fluid extract, topically, and, from an unpardon- 
able neglect in recording symptoms, am unable to give you a 
single indication, save that empirical one of Hale's — " Varicosed 
veins." 

Hepar SUlph. Over-sensitiveness and irritability, with quick, 



Special Therapeutics. 309 

hasty speech ; heat, and fiery redness of the face ; yellow color 
of the face, with blue border around the eyes; deadness and 
tingling of the fingers ; swelling of the feet around the ankles ; 
weakness in all the limbs — they feel bruised. 

Worse at night ; also from cold, from pressure, and when lying 
on the painful side. 

Better from warmth. Either side. 

HyOSCyamilS nig. Delirium without consciousness ; has no 
want except thirst ; when spoken to the answer is properly 
given, but he immediately relapses into unconsciousness and de- 
lirium ; vertigo, with obscuration of sight, as from intoxication ; 
heat and redness of the face ; thirst, drinking but little at a time ; 
distension of the abdomen, with pain when touched ; slow, rat- 
tling breathing ; painful numbness of the hands ; trembling of the 
arms ; swelling of the hands ; uncommon sinking of strength ; 
cold, sour-smelling perspiration ; hot, dry, and brittle skin. 

Worse in the evening ; also after eating or drinking. 

Better by stooping. 

kjnatia am. Intolerance of noise : heaviness in the head ; 
sore, bruised sensation in the head ; alternate redness and pale- 
ness of the face ; clay-colored, sunken face, with blue margin 
around the eyes ; nausea, without vomiting ; impeded breathing, 
with suffocating attacks ; sensation of numbness in the arms at 
night when in bed, with feeling as if something living were run- 
ning in the arm ; heaviness of the feet ; the feet are cold, extend- 
ing even to the knees ; trembling of the limbs ; great sensitive- 
ness of the skin to a draft of air. 

Worse in the evening, and in the morning ; also from taking 
coffee, tobacco, or brandy. 

Better when lying on the back, or when changing the position. 

Jodilim. Restlessness, with constant desire to move about, not 
permitting one to sit or sleep ; feeling as if a tape, or a band, were 
drawn tightly around the head ; throbbing in the head at every 
motion ; the white of the eye is of a dirty yellow color ; alternate 
canine hunger and want of appetite ; gastric derangements, with 
constipation ; coldness of the hands ; cedematous swelling of the 
feet; great emaciation, even with good appetite; great debility — 
even talking causes perspiration ; internal dry heat, with external 
coldness. 

Worse at night, and in the evening; also when fasting, from 




3 1 o Surgical Diseases of the Blood- Vessels. 

lying on the painful side, from pressure, from warmth, and when 
walking quickly. 

Better from cold ; after eating. 

Kali carb. Trifles vex one ; noise is disagreeable ; giddiness, 
as if proceeding from the stomach ; the white of the eye is red, 
the capillaries being injected ; sensation of coldness in the eyelids; 
face bloated, of a yellow color ; weakness, loss of strength in the 
arms ; cold hands ; restlessness of the legs in the evening ; swell- 
ing of the feet up to the ankles ; a short walk fatigues much. 

Worse in the morning ; also when at rest. 

Better in the open air, and while exercising. 

KreOSOte. Constipation ; stools hard and dry, and only ex- 
pelled with difficulty ; stitches in rectum, extending towards left 
groin ; cedematous swelling of both feet ; livid complexion, with 
swelling of cervical glands ; great drowsiness, with frequent yawn- 
ing ; tossing about all night, without any apparent cause ; faint- 
ness when rising too early in the morning ; restlessness of the 
body while reposing. 

Worse in morning , in the open air on moving ; from eating 
cold food. 

Better from warmth. 

Lachesis. Constipation, with ineffectual effort to evacuate ; 
stools very offensive ; sensation as if there was a plug in the anus ; 
hemorrhoidal tumors protrude after the stool, with constriction of 
the sphincter ; large hemorrhoidal tumors ; dark-colored piles ; 
uneasiness of lower limbs ; trembling of the legs ; sensation as if 
a hot iron were going through the knee-joints; swelling of the 
knees ; coldness and swelling of the feet ; tearing, pricking, or 
pulsating pains ; inclination to lie down, and averse to moving. 

Worse in the evening, and periodically ; also in open or cold 
air, after sleep, or drinking acids or alcoholic drinks. 

Better from warmth ? Left side principally. 

LauroceraSUS. Dullness of senses ; inability to collect one's 
ideas ; insensibility, and complete loss of sensation ; loss of con- 
sciousness, with loss of speech and motion ; painless paralysis of 
the limbs ; want of energy of the vital powers, and want of reac- 
tion. 

Worse in the evening. 

Better at night, and in the open air. 

Ledum pal. Desire for solitude ; the least covering is intoler- 



Special Therapeutics. 311 

able to the head ; glandular swelling under the chin ; constipa- 
tion, the stool being mixed with blood ; diarrhoea, the stool 
mixed with mucus and blood ; swelling, tension, and stitches in 
the knee ; swelling of feet up to the knee ; hot swelling of the leg, 
with stinging, drawing pain ; dryness of the skin, and want of 
perspiration ; burning in the limbs ; lack of vital heat. 

Worse in the evening, and at night ; also from the heat of the 
bed. 

Better when keeping still. 

Ly CO podium. Small stool, in constipation, with feeling as if 
some were not expelled ; haemorrhage from the rectum, even after 
a soft stool ; fullness in the rectum, continuing after a copious 
evacuation ; stitches in the rectum ; painful closing of the anus ; 
protrusion of the varices ; distension of the haemorrhoids ; swell- 
ing of the feet around the ankles, with cold perspiration ; weeping 
mood, extremely sensitive and irritable ; numbness of the limbs, 
feeling as if the circulation had ceased ; great emaciation, and in- 
ternal debility ; the whole body feels bruised ; faintishness at cer- 
tain hours during the day ; disposition to take cold ; uneasiness, 
or longing for the open air. 

Worse in the evening ; also when lying down, or sitting, or be- 
ginning to walk, eating or drinking cold things, and from the 
pressure of the clothes. 

Better on getting cold, on continuing to walk, and from warm 
food and drink. 

Manyanum. Out of humor, low-spirited, and reflective ; con- 
tractive pain in rectum when sitting ; red, shining swellings of the 
affected parts ; inflammatory swellings and suppurations ; every 
part of the body feels sore when touched. 

Worse at night ; also on stooping or being touched. 

Better. Symptoms that are worse in the room are better in the 
open air, and vice versa. 

MerCUrillS Viv. Indifference to everything ; continuous moan- 
ing or groaning ; fainting after sweetish rising in the throat, fol- 
lowed by sleep; vertigo, as if one were in a swing; great debility 
and weakness, with trembling and ebullitions from the least exer- 
tion ; inflammations, ending in suppurations and exudations ; great 
tendency to perspiration ; perspires with every movement. 

Worse in the evening, and at night ; also before falling asleep, 
during perspiration, when exercising, and from the heat of the bed. 



312 Surgical Diseases of the Blood- Vessels. 

Better in the morning, when at rest, and when lying down. 

Muriatic acid. Sadness, peevish, irritable; vertigo, with tot- 
tering gait ; hemorrhoidal tumors, swollen, blue, with burning 
soreness; great debility as soon as he sits down, the eyes close, 
lower jaw hangs down ; he slides down in the bed ; great sensi- 
tiveness to damp weather ; wakens early in the morning with a 
chill. 
. Worse in the afternoon ; also when sitting down. 

Better from motion. 

Natrum mur. Indifference, taciturn, tendency to start ; sad 
and weeping ; difficulty of thinking ; hemorrhoidal tumors, with 
stinging pain; stools hard and dry, crumbling like sheep's-dung ; 
great weakness and relaxation of all bodily and physical powers, 
from the least exertion ; disinclination to move and walk after 
rising ; great emaciation ; pulsations in the whole body from the 
least exertion; restlessness in the limbs — they have to be moved 
constantly. 

Worse in the forenoon ; also from exertion, talking, using acids, 
and from anger. 

Better while fasting, when lying on the back, and after lying 
down. 

Nitric acid. Irritable; sadness, despondency; vertigo, more 
especially in the morning, obliging one to lie down ; varices of 
the anus, swollen, burning, and bleeding after every evacuation ; 
pricking pains as if from splinters, especially from contact ; great 
debility, with heaviness of the limbs, especially in the morning ; 
trembling of the limbs ; sleepiness during the day, from debility, 
with vertigo. 

Worse in the evening, and at night ; also on touching the parts, 
on walking, and on rising from a seat. 

Better from warmth. 

NlIX vomica. Over sensitive to external impressions, as noise, 
smells, light, and music ; the time passes too slow ; laziness and 
aversion to occupy himself; painful blind piles; great debility 
of the nervous system ; sensation of heaviness of the body, alter- 
nating with sensation of lightness; feeling of soreness all over the 
body in bed in the morning; disposition to take cold, with great 
sensitiveness to the open air, and aversion to drafts of air, at- 
tacks of fainting. 

Worse in the morning; from noise, eating, and light touch. 



Special Therapeutics. 313 

Better from strong pressure. 

Platina met. Low-spirited, inclined to shed tears ; indiffer- 
ence ; tension in the limbs, as if they were wrapped up tightly ; 
numbness and stiffness, with paralytic sensation in the limbs. 

Worse in the evening ; also when at rest. 

Better from motion. 

Pulsatilla. Gloomy, melancholy, weeps easily; piles with great 
soreness ; tension in inner parts and joints ; inflammation of inter- 
nal organs, with disposition to suppurate ; pulsations through the 
whole body ; frequent anxious trembling of the limbs ; attacks of 
fainting with great paleness of the face ; inflamed varices. 

Worse in the evening, and at night ; also from warmth, on begin- 
ning to move, and when lying on the left or painless side. 

Better from slow motion, in the open air, or from cold. 

Rhus tOX. Absence of mind ; inclination to weep, with desire 
for solitude ; great debility, weakness, and soreness ; painless par- 
alysis of the limbs ; numbness in the extremities, with previous 
twitching and tearing in them ; the parts on which one lies go to 
sleep; restlessness of the body, with inclination to move the 
affected parts ; hard swelling of the affected parts. 

Worse in the morning; also when at rest, on beginning to move, 
when the weather changes, and from cold. 

Better from motion and from warmth. 

Ruta grav. Anxious and low-spirited, with mental dejection; 
sensation of soreness in the part on which one lies. 

Worse in the afternoon ; also during rest, in cold weather. 

Better from motion. 

Sepia. Sadness with weeping; great indifference; restless, 
fidgety ; heavy flow of ideas, and weak memory ; piles protrude ; 
discharge of blood with the stool ; mucus from the rectum, with 
stinging burning; heaviness in the body; inflammatory swellings; 
tingling in outer parts ; limbs go to sleep easily after manual labor, 
vibrations like dull tingling in the body ; a short walk fatigues 
much; aversion to the open air; weakness of the joints. 

Worse in the forenoon and evening ; also from mental exertion, 
and when at rest. 

Better from warm air. 

Spigelia. Difficulty in thinking, and disinclination to mental 
exertion ; weakness of memory ; heaviness and soreness of the 
body when rising from a seat ; painful sensitiveness of the body to 



314 Surgical Diseases of the Blood- Vessels. 

the touch, with chilliness of the parts touched, or with tingling 
running through the body. 

Worse in the night and in the forenoon ; also from the least 
movement, from touching the parts, and when walking in the open 
air. 

Better after lying down. 

Staphisayria. Weakness of memory; twitches at night; the 
muscles are painful to the touch, and the joints on motion ; skin 
is hard to heal. 

Worse from motion strong mental emotions and touch. 

Better in evening, and after breakfast. 

Sulphur. Dullness ; difficulty of thinking, misplaces or cannot 
find the proper words when he speaks ; piles oozing or bleeding ; 
feeling of tension in outer parts and in joints ; feeling of heaviness 
in inner parts ; feeling of fullness in inner parts ; feeling as if a 
hoop or a band were around parts ; trembling and shaking of outer 
parts ; the limbs go to sleep ; great debility and trembling ; talking 
fatigues ; aversion to washing. 

Worse in the evening, and periodically ; also from bodily exer- 
tion, on getting warm in bed, while at rest, and from touch. 

Better from motion and from -heat. 

Tartar em. Lethargy ; hilarity in the day, anxious and timid 
in the evening ; attacks of fainting ; internal trembling ; heaviness 
of all the limbs, with debility ; pulsation in all the blood-vessels. 

Worse in the evening ; also when sitting, and from warmth. 

Better in the open, cold air. 

Thuja. Has a clinical reputation for Nevus. 

Veratrum. Sudden sinking of strength; continuous weakness 
and trembling ; numbness and tingling in the extremities ; attacks 
of fainting from the least exertion ; coldness of the skin, which is 
wrinkled. 

Worse in the morning ; also during perspiration. 

Better after perspiration. 

ZillCUm. Aversion to talking or working; weakness of the 
memory ; pulsations through the whole body ; violent trembling 
and twitching of the whole body; 

Worse in the afternoon and evening ; also in a warm room. 

Better in the open air. 



Special Therapeutics. 315 

Operation for Varix. 

The operation is performed by sticking a hair-lip pin through 
the integument under the vein, and twisting silk or wire around it 
in a figure-of-eight form. 

ARTERITIS. 

Arteritis is an inflammation of the arteries, and, like phlebitis, 
is caused either by injury as from a ligature, or is idiopathic, or 
rather, is caused by some constitutional taint, of a nature with 
which we are entirely unacquainted. The two varieties recognized 
by surgical writers, are adhesive or limited, and diffuse or erysipeloid. 
The former may be acute or chronic, idiopathic, or of a traumatic 
origin ; the latter is always the result of injury. 

In adhesive or limited arteritis, from the pressure of tumors, or 
long-continued pressure of any sort, the coats become thickened 
and fused together, finally forming an imperforate cord. This is 
very common in the chronic variety. The result may be the estab- 
lishment of a collateral circulation, the absorption of the clot and 
consequent re-establishment of the circulation, or, in connection 
with the collateral circulation, a necessary obliteration of the main 
trunk. 

Diffuse Arteritis differs from the preceding variety, in that the 
disease extends over a wider extent of surface, and is attended by 
plastic exudation. One of the most to be dreaded results is that 
of gangrene, which may be very readily set up if a large arterial 
trunk be the seat of the disease, and the diseased action should 
progress rapidly ; particularly is this to be dreaded if a plug should 
form suddenly. 

The symptoms are, pain, depending on the situation of the vessel 
— either superficial or deep, tenderness to pressure, and coldness 
of the limbs. The artery can be felt pulsating in jerks. The 
point immediately below the inflamed portion is always the most 
susceptible to pressure or touch, and this is sometimes excessively 
acute ; this is most always the case when the artery is superficial, 
and is then attended with some loss of muscular power, and the 
pain is of a neuralgic character. When the artery is deep-seated, 
the pain is an intense burning, and is felt along the course of the 
branches of the vessel. When the plug is forming, there are 



3 1 6 Surgical Diseases of the Blood- Vessels. 

many symptoms which point to the difficulty to be apprehended. 
The pulsations below that point become gradually weaker, until at 
last when it is completely formed, it ceases altogether, and the 
limb, which all along had been falling in temperature, becomes 
cold and discolored, while the sensibility continues. Gangrene 
may invade the part in one of two forms, the senile or dry, and 
the moist; the former if the arteries alone are affected, and the 
latter when there is a complication of phlebitis ; the sensibility in 
both instances of course, diminishing as the gangrene advances. 
When gangrene is fully formed, of course destruction of the limb 
ensues, and amputation is the last resort. 

Fatty Degeneration of Arteries. 

This consists in the deposit of fat in the coats of the vessel. 
The diagnosis is not at all certain during life. The circulation is 
feebler from the want of elasticity of the vessel, and from the fact 
of its being incapable of providing the requisite amount of blood 
for the parts it supplies, atrophy,.or even death of the part ensues. 
This disease is only or chiefly of interest from a pathological point 
of view. 

Calcification. 

This is a deposit of calcareous material on the inner coat of the 
vessel, which may assume almost any shape, exist in any quantity, 
and affect any extent of the vessel, which, in some instances, may 
be converted into a firm, unyielding tube. It is exceedingly diffi- 
cult to determine positively the nature of the disease, and this will 
materially obscure the plan of treatment. We should be guided 
by the few pathognomonic indications, and good common sense. 

Aneurisms. 

This is an enlargement or dilatation of an artery, either of all 
the coats, to a certain extent, or of only one, with a rupture of the 
others. Erichsen gives us three varieties : the fusiform, saccu- 
lated, and dissecting, sub-dividing the second class into two varieties, 
the true and the false. 

(i.) The Fusiform, the whole of the vessel at one point is pre- 
ternaturally dilated, each of the coats uniformly, and is sometimes 



Special Therapeutics 317 

known as the "tubular" The aorta is the vessel usually the seat 
of this variety, but it is occasionally met with elsewhere. The 
disease does not consist alone in a simple dilatation, but in addi- 
tion to all the coats being thickened and elongated, the outer one 
is particularly so, the middle has lost its elasticity, and the internal 
studded with deposits. 

(2.) Sacculated aneurism proceeds often from the former variety. 
It consists of a tumor bulging out at the side of an artery, formed 
of its coats. Circumscribed sacculated aneurisms are those in which 
the blood is contained in the sac, no matter how large the sac may 
be. The diffused form are those in which the sac has burst, the 
blood poured out into the surrounding cellular tissue, but still being 
limited by a condensation of this tissue. Previous to one of the 
coats giving way, the coat so ruptured becomes firmly attached to 
the one remaining intact, so that the blood does not find its way 
between them, but when this does not occur, by reason of this 
failure we have another variety, called the 

(3.) Dissecting aneurism, that is, the blood passes between two 
of the coats, separating them from each other. The terminations 
of this condition may be, the blood, after forcing itself for some 
distance, will burst through the external coat, and become 
effused into the surrounding parts ; or, the external coat being 
too firm, it will open again through the internal coat, and thus an 
apparent septum be formed in the vessel; or, finally, both the 
internal and external coats being too strong to admit of an open- 
ing being formed, a sac may form in the very substance of the 
vessel, closing it up internally, and finally one or more coats will 
give way, and either a false sacculated aneurism result, or all the 
coats giving way, except external or internal, the blood be poured 
out into the neighboring parts, or form the second variety by 
opening into the cavity of the artery again. 

In determining upon the treatment you must take into consid- 
eration, first, the locality; second, the effect that pressure would 
produce upon the neighboring parts; and third, as near as possible 
the form. The pressure exerted by these tumors on neighboring 
parts, is a very important phenomena to study, as these effects 
often are the only means we have for forming a correct diagnosis. 
Important veins are not unfrequently thus compressed, and varix, 
phlebitis, or even complete obliteration ensue ; so also the nerves, 
air passages, or other arteries. The injurious effect of such pres- 



3 1 8 Surgical Diseases of the Blood- Vessels, 

sure on bones is fully shown in the disorganization and absorption 
they undergo. Aneurismal tumors on superficial vessels may 
generally be very readily detected by their shape and the pulsation 
communicated to the touch. Pulsation alone will not be suffi- 
cient ; a tumor may rest upon an artery, and the pulsation in the 
latter be communicated to the former; raising the tumor will 
detect it, if such is the case, unless the artery pass through it. 
But the surest plan is to compress the artery firmly above the 
tumor, and if the pulsation in it ceases, joined to the other manip- 
ulations, you may consider the case made out. In diagnosing a 
deep or " internal " aneurism, the chief attention is to be paid to the 
" pressure effects," and to the sound of the beat at that point, 
which is louder than normal and of a rasping or scraping char- 
acter. If, however, the aneurism is of the sacculated variety, and 
that with a small neck, this sound will not be heard, and hence a 
difficulty will be experienced in determining whether it be an 
aneurism or some other tind of tumor. I should not waste much 
time in use of remedies, but tie the vessel, or keep up continuous 

pressure. 

Aneurism by Anastomosis. 

This is perhaps the most dangerous of all the varieties of aneu- 
rism. It consists in a condition of the arteries resembling varix, 
and the resemblance is further shown, as the coats of the vessel 
are very thin, as well as the course being marked with a number 
of pulsating little pouches, looking like the valvular enlargements 
of the veins. They are usually found at a distance from large 
trunks ; the tumors externally are of a bluish color, warmer than 
the surrounding skin; the beat is synchronous with the heart; 
they are irregular in shape; of a doughy feel; not circumscribed; 
and large tortuous vessels are felt running into them from various 
directions. On compressing the tumors the beating is partially 
suspended, and, on remitting it, the blood returns into it with an 
expansive beat, and sometimes with some violence as if ejected 
from a syringe. The beating, however, is not a regular pulsation, 
but rather a thrill. The sound of this circulation is usually loud> 
though it may be soft and blowing. 

Nevus. 

This disease, though not strictly an arterial one, is inserted here 
because it is more intimately associated with this class ofdiseases 



Special Therapeutics. 319 

than any other. It may be arterial, capillary, or venous in its form. 
Arterial nevi are simple aneurisms by anastomosis in miniature. 
The disease, in all of its forms, is essentially an excessive devel- 
opment of the vascular tissue of the part. Capillary nevi are 
slightly elevated, but flat spots on the skin; in color are bright- 
red or purplish, and larger vessels can be seen ramifying on their 
surface, which is slightly roughened. They are congenital, and 
vary greatly in size, from that of a pea, to as large as a hand, or 
larger. Their seat is usually on the head or neck, the face often- 
est, although they may be found on any part of the body. If left 
alone they may be removed spontaneously, frequently by a sort ot 
an ulceration that produces more deformity than pre-existed, from 
the resulting cicatrix. The haemorrhage from them is not at all 
alarming, being a mere trickling. Venous nevi are quite large in 
some positions, and differ materially from the other varieties in not 
being compressible, and in color, which is a dark-brown. They 
are not at all painful, and apart from the blemish, are not trouble- 
some. Sometimes they are soft, and compressible to a slight 
degree, and on being submitted to pressure are quite flat, but fill 
up again quickly when the pressure is removed. I consider them 
quite amenable to treatment. 

Treatment. — Arteritis: Aeon., Am., Ars., Bell., Bry., 

Calc., Chin., Con., Hep. s., Lack., Lye., Merc., Nux vom., 

Phos., Puis., Rhus, Ruta, Sil., Sulph., Thuja. 
Arteritis: From Ligature and Injury. — Aeon., Am., Bell., Bry., 

Hep. s., Rhus. 

Idiopathic. — Aeon., Bell., Bry., Calc., Chin., Lach., Merc, 

Nux v., Phos., Puis., Rhus, Ruta, Sil., Sulph., Thuja. 

Adhesive. — Aeon., Am. Ars., Bell., Bry., Chin., Con., 

Lach., Merc., Nux v., Puis., Rhus, Sil., Sulph. 

Diffuse. — Aeon., Am., Ars., Bell., Chin., Hep., Lye, Merc, 



Rhus, Sil., Thuja. 

— Gangrene from. — Ars., Bell., Lach., Rhus, Sulph. 



Fattv Degeneration: Aeon., Ars., Aur., Borax, Calc, Chin., 

Caust., Ferr., Nux v., Phos., Puis., Sulph. 
Calcification: Calc. c, Dig., Ferr., Kali c, Phos., Rhus, Sil., 

Sulph. 
Aneurism: Ambra., Arn., Ars., Bry., Cact. g., Calc, Car bo v., 

Caust, Con., Dig., Ferr., Graph., Guaj., Lach., Lad., Lye, 

Nat. m., Phos., Puis., Rhus, Ruta, Sil., Spig., Sulph., Zinc. 



320 Surgical Diseases of the Nerves, 

Aneurism of the Aorta particularly. — Ars., Cact. g., Calc, Carbo 

v., Dig., Graphs Lack., Lye, Nat. mur., Puis., Rhus, Spig., 

Sulph., Zinc. 
by Anastomosis. — Acetic ac, Aeon., Bell., Cact. g., Dig., 

Phos., Rhus, Sulph. 
Nevus: Acetic ac, Ars., Borax, Calc, Hep. sul., Iod., Lach., Lye, 

Merc, Si/., Sulph., Thuja. 

Operations. 

Aneurism is the only one of the true arterial diseases that admits 
of an operation. The mechanical means in most common use are 
ligation and pressure. The ligatures must be placed on the vessel 
at some distance from the tumor. Of late years the treatment 
by pressure has been much and successfully practiced, and will 
undoubtedly in time supercede all others. This is effected either 
by an apparatus, like a hernia truss, or else by the fingers of 
assistants. 

Nevi are usually treated by passing silk backwards and forwards 
through their substance, and thus strangulating them. Some 
excise them; and some again destroy them by active escharotics. 
The best of all is to remove them by remedies. 



SURGICAL DISEASES OF NERVES. 

NEURALGIA, NEURITIS, NEUROMA, TETANUS, 

WOUNDS. 

Neuralgia. 

Neuralgia is a condition which, when neglected, becomes 
neuritis. One is an irritation, and the other an inflammation 
subsequent to it. The development of neuralgia is almost always 
due to some local irritation. Pressure of some foreign material 
upon the nerve, or any cause that induces nervous prostration 
may induce it. The disease may affect almost any part of the 
body. The symptoms are these ; pain in the course of the 
nerve, of all degrees of severity, which is sometimes so very 



Neuritis. — Neuroma. 321 

severe that the strongest persons are totally incapacitated from 
performing any of their ordinary occupations. It may come on 
gradually, or suddenly like an electric shock, and be accompanied 
with increased secretions from the part affected, or a partial or 
total suppression. The pain may be prickling, burning, shooting, 
throbbing, or steady. The skin is extremely sensitive to touch, 
but is sometimes not so much so to strong and continued pressure. 
When it becomes chronic, I consider the disease to have changed 
its nature, and become 

Neuritis. 

This is an inflammation of a nerve, and is commonly seen after 
some direct injury inflicted on the nerve, as in operations. It 
also follows rheumatism and strains. It results in softening of 
the nerve substance. The pain is similar to that of neuralgia, 
but is not intermittent, and is not apt to recur after it has 
disappeared. The skin is not so sensitive to pressure, but there 
is tenderness along the track of the nerve, and some swelling. 
The only points of difference between the two forms, is, that 
one is acute, the other chronic ; one periodic, the other not. 

Neuroma. 

These are tumors of a fibrous consistence, connected with the 
nerves, but not composed of nerve tissue. They are most com- 
mon in connection with the nerves of the spinal system, although 
they are occasionally seen in connection with those of the gan- 
glionic. In structure they resemble very closely the neuromatous 
tumor, and are found to be surrounded by nervous filaments, 
some few of which may pass through its substance. The nerve, 
of course, is more or less affected when the tumor presses upon 
it, but above and below it is normal in appearance, at all events. 
When they occur singly, or when only one or two are found, 
they are extremely painful, but — and it is a remarkable fact — 
that when there are great numbers of them, they are entirely pain- 
less. They may give rise to neuralgia, followed by neuritis. In 
shape they are usually oblong, with their long axis parallel to the 
course of the nerves, and may be freely moved in any direction 
save that in the course of the nerve. In size they may be from 

31 



322 Surgical Diseases of the Nerves, 

that of a mustard-seed to as large as the fist, or larger. They may 
also exist in any number, from one to several hundred, and are 
more apt to attain a large growth when single, than when in great 
numbers. When these tumors follow operations, and occur in the 
divided extremity of a nerve, it is due to a ragged or lacerated 
wound, or to some abnormal condition of the nerve. The pain 
in such tumors is excruciating, and has frequently called for re- 
amputation, or exsection of the nerve. 

Tetanus. 

This is one of the most formidable looking diseases to treat 
imaginable, but a careful selection of the remedy will prove it 
otherwise. We have four recognized varieties, each of which is 
usually ushered in by the appearance of the first mentioned. They 
are — ist, Trismus, or, as it is commonly called, " locked-jaw ; " 
2nd, Opisthotonos, in which the body is bent backwards, so that 
it rests on the heels and occiput ; 3rd, Emprosthonos, in which 
it is similarly curved forward ; and 4th, Pleurosthotonos, in which 
it is bent to one side. In all the varieties, the body is rigid, 
and the face drawn into an expression of the most intense agony. 
Unlike most spasms, the muscles after once becoming rigid do 
not relax again until the disease is removed. The principal 
symptoms are as follows : — Closing of the jaws, which cannot be 
opened ; difficult, or impossible deglutition ; rigidity and immo- 
bility of the limbs and trunk. 

Wounds of Nerves. 

The degree of danger is dependent upon the size of the nerve, 
and its importance in the economy. If the pneumogastric nerve is 
severed, or materially injured, so that its function is destroyed, it is 
followed by death. Other nerves of motion, more particularly if 
injured give rise to a paralysis of all muscles below the seat of 
injury. When a portion of a nerve is entirely removed, of course 
paralysis of the parts it supplies will follow; but it sometimes hap- 
pens that the portion so removed is small, and a subsequent 
imperfect union of the cut ends follows, followed again by just as 
imperfect a restoration of junction. Dr. McClellan, of Philadel- 
phia, operated for the removal of a parotid gland ; he found the 



Special Therapeutics. 323 

pneumogastric, spinal accessory nerve, and portia dura, involved 
in the diseased mass. The tumor was excised, and with it a por- 
tion of the pneumogastric two inches in length; "strange to say, 
scarcely any impediment to respiration was experienced, and the 
patient recovered." This case is reported to show that there are 
exceptions to the above rule, in which the important functions ot 
the pair, can be carried on by one alone. 

When the nerve has been divided, partially or completely, or 
when a vein has been excised, Staphisagria, internally and exter- 
nally, will prove the quickest remedy in promoting a union of the 
cut ends. Calend. may be found more useful in cases of excision, 
and is to be given in the same way. When pricks from sharp 
instruments, bruises, or neuralgia from these causes is the trouble, 
Arnica, or Conium will be the best remedy. For external applica- 
tion, the tincture is always to be understood, ten drops to an ounce 
of water. Internal administration, the 30th is to be understood, 
and when another attenuation is desirable it will be named. " 

Treatment. — In selecting a list of remedies to consult for 
the treatment of these affections, I am almost afraid that they will 
confuse rather than aid, but it is impossible to abbreviate ; indeed, 
it is much easier to add to the indications. 

Neuritis : Aeon., Apis., Ars., Bell., Bry., Canth., Caps., Chin., Con., 
Dig., Euph., Lye., Merc., Nux v., Puis., Rhus, Sep., Sil., Sulph., 
Verat., Zinc. 
Neuralgia: Aeon., Anac, Am., Ars., Asa/., Aur., Baryta, Bell, 
Bry., Camph., Carbo v., Caust., Cham., Chin., Cimicifuga, Cina., 
Coff., Coloc, Con., Cypripedium, Elaterium, Ferr., Gels., Graph., 
Hep., Hyos., Ignat., Ipec., Kali e, Kalmia lat., Lach., Lye, 
Magnes., Mangan., Merc, Mezer., Nit. ac, Nux v., Oleand., 
Petrol, Phos., Phytol., Plat., Puis., Rhus t., Rhus r., Sabad., 
Sep., Sil, Spig., Stan., Staph., Teucri., Thuja, Valer., Verat. 
Neuroma — Idiopathic: Aeon., Am., Bell, Calend., Calc, Lye, 
Merc, Rhus, Ruta, Sil, Thuja. 

traumatic: Am., Aeon., Bell, Bry., Calend., Con., Chin., 

Rhus, Ruta, Sulph. 

(sub-cutaneous tubercle) : Aeon., Arn., Ars., Aur., Calc, 
Dig., Lye, Merc, Nux v., Puis., Rhus, Ruta, Sil., Sulph. 
Tetanus: Aeon., Ammo. e.,Angust, Arn., Camph., Cham., Cie v., 
Cocc, Gels., Hyos., Ign., Lye, Merc, Nat. m., Opi, Phos., Rhus, 
Staph., Stram., Sulph., Verat., Canth., Cin., Gratiola, Ipec, 
Nux v., Plat., Secale, Stan. 



324 Surgical Diseases of the Nerves. 

Trismus: Angus?., Bell., Cicuta v., Hyos., Lack., Merc, Stan., Aeon., 

Ammo, c, Am., Ign., Opi., Sir am. 
Opisthotonos: Bell., Hyos., Ign., Op', Rhus Viper a redi. 
Emprosthotonos : Coloc, Ign.. Hyos., Stan. 
Pleurosthotonos : Aeon., Bell, Bry., Hyos., Phos., Sir am., Stan. 

Aconite. Vertigo on rising up in bed; crampy sensation at 
root of nose, making her feel as if going crazy ; feeling as if the 
whole brain would press out at the forehead ; she fears to be in a 
place of excitement or confusion. Insupportable pains, especially at 
night ; shooting or pulsating pains ; thirst ; redness of the cheeks ; 
small and quick pulse ; great sensitiveness of the whole nervous 
system, especially of the organs of sight and hearing. 

Worse in the evening and at night ; also from warmth. 

Better when at rest and in the open air. 

Ammonium Carb. Feeling as if the head would burst; anxiety, 
with inclination to weep ; discharge of sharp, burning water from 
the nose; pale, bloated face; much thirst; debility, compelling 
one to lie down ; great sensitiveness to cold ; tearing and burning 
pains ; pulse hard, tense and frequent ; attacks of chilliness in 
the evening ; during the day and in the morning, perspiration, 
principally about the joints. 

Worse in the evening ; also from wet poultices and pressing the 
teeth together. 

Better from pressure and warmth. 

Anacardium. Loss of memory: fluent coryza; loss of taste; 
diminished sensibility, particularly of smell, sight and hearing; 
sensation as if a hoop or band were around the parts ; pulse accel- 
erated, with beating in the veins ; coldness internally, with exter- 
nal heat ; clammy perspiration of palms of the hands. 

Worse in morning, periodically ; also from rubbing. 

Better during dinner. Left side. 

Angustura. Excited; easily starts; heat and bluish redness 
of the face ; tension in the muscles of the face ; the lips are drawn 
back showing the teeth; thirst, but no desire to drink; pulse 
accelerated, spasmodic, intermitting, and at times irregular. 

Worse in the morning ; also from touching the parts. 

Apis mel. Restlessness ; twitching of the eye-balls ; cedema- 
tous swelling of the lids; redness and swelling of both ears; 
burning or stinging heat in the face, with purple color ; oedematous 
swelling of the face; thirstlessness ; tension over the eyes, behind 



Special Therapeutics. 325 

the ears and in the neck; pulse full and rapid, or small and 
trembling; intermitting pulse ; chilliness from the least movement, 
with heat of the face and hands ; sharp pains like a bee-sting. 
Worse in the morning, evening, and at night ; also from heat. 
Better from cold. Left side. 

Arnica. Crawling, pricking in the part ; agitation and restless- 
ness, which compel the patient to move the parts continually ; 
great sensitiveness to noise; heat of face, cold body; hot, red, 
shining swelling of one cheek ; burning, hot, cracked lips ; thirst, 
desire for cold water; longing for alcoholic drinks; pulse very 
variable, mostly hard, full, and quick; internal chilliness, with 
external heat ; perspiration smelling very sour, sometimes cold. 

Worse in the morning, evening, and at night ; also on moving, 
being touched, and from cold. 

Better from warmth. 

Arsenicum. Burning or tearing pains, felt even during sleep; 
pains become insupportable, so that he becomes furious, and de- 
spairing; great anguish; excessive weakness, so that he has to lie 
down ; intermission of the pain, when sensation of coldness in 
the part affected ; the pain is so great that the patient is contin- 
ually moving from room to room, or place to place ; swelling and 
burning of the nose; fluent coryza of burning, sharp, excoriating 
water ; puffiness of the face, especially around the eyes ; distorted 
features ; lips black, dry and cracked ; longing for cold water, 
acids, and alcoholic drinks; sudden sinking of strength; pulse 
frequent in the morning, slower in the evening; skin dry, like 
parchment. 

Worse at night, and in morning; also from cold, when lying on 
the affected side. 

Better from heat in general. 

Asaftetida. Hysterical restlessness and anxiety ; sensation of 
numbness of the bones of face; twitching and jerking in muscles; 
pulse small, rapid, and unequal. 

Worse in the afternoon and evening. 

Better in the open air. Left side. 

Alirum met. Melancholy mood, dejected, inclined to weep, 
and longing to die ; almost driven to suicide ; fiery sparks before 
the eyes ; roaring in the ears ; very sensitive smell ; bloated, 
shining face; immoderate thirst; hysterical spasms with laughing 
and crying alternately ; pulse is small, but accelerated. 



326 Surgical Diseases of the Nerves. 

Worse in the morning ; also from cold. 

Better from motion and warmth. 

Baryta C. The light hurts the eyes ; in the dark he sees spots 
before them ; dark redness of the face ; tension on the face as if 
it were covered with spider's webs ; flushes of heat ; pulse weak, 
but accelerated. 

Worse at night ; also when thinking of it. 

Better in open air. 

Belladonna. Nervous anxiety and restlessness ; eyes sparkling, 
red and glistening; looks wild, unsteady; inflammation of the ear; 
dullness of hearing ; inflammation and redness of the nose ; sense 
of smell preternaturally acute ; purple-red and hot face ; alternate 
redness and paleness of the face; spasmodic distortion of the 
mouth ; violent cutting pains ; the upper lip is swollen ; excessive 
burning thirst ; inability to swallow ; pulse accelerated, often full, 
hard and tense ; sometimes soft and small ; if slow the pulse is 
full ; dry heat, with thirst ; perspiration on the head, or only on 
those parts that are covered ; the patient seems to be in a stunned 
or stupid condition. 

Worse at night ; also from the least touch, from light, or noise. 

Better while lying down. Right side. 

Bryonia. Exceedingly irritable, inclined to be angry ; burning 
in the eyes, and edges of the eyelids ; the eyes feel as if pressed 
out of the head; the upper lids are particularly swollen; does not 
drink often, but much at a time ; swelling of the affected parts, 
with inability to move them ; pulse full, hard, and tense ; perspira- 
tion profuse, and very easily excited ; desire to keep very still. 

Worse in the evening ; also from motion, or sitting up in bed, 
and from heat. 

Better on getting warm in bed. Right side. 

Calendula Off. Provings of this remedy are very incomplete, 
but the little use I have made of it justifies me in recommending 
its use, topically at all events, in neuritis resulting from a lacerated 
wound. 

Camphora. Great anguish and discouragement; confusion of 
ideas ; aversion to light ; usually thirstlessness ; sometimes violent 
thirst; sudden and great sinking of strength; death-like paleness 
of the face, alternating with redness ; icy-cold face, purple or pale; 
distorted countenance; foam at the mouth; icy-coldness of whole 
body, with paleness of face; pulse small, weak and slow; cold 
perspiration, often clammy, and always very debilitating. 



Special Therapeutics. 327 

Worse at night; also from cold. 

Better when thinking of it. 

Cannabis ind. (From Hale.) Heat of the skin ; copious per- 
spiration; pulse very slow, with nausea; general restlessness; 
desire to sleep, but inability to do so; dry mouth and thirst. 
Even these few unimportant symptoms are, I fear, far from being 
reliable. They are all I can find, however. 

CantharideS. Anxious restlessness, ending in rage; eyes pro- 
truding; fiery, sparkling, staring look; death-like appearance; 
expression of terror and despair; hot, red, and swollen face; thirst, 
but yet an aversion to all fluids ; pulse hard, full, and rapid ; 
burning heat, with anxiety and thirst ; cold perspiration, smelling 
like wine. 

Worse in the afternoon and night ; also from coffee. 

Better from lying down. Right side. 

Capsicum. Peevish, easily offended; redness of the cheeks 
without heat, often changing to paleness ; swollen and cracked 
lips; thirstlessness ; pulse irregular, and often intermitting; heat, 
with perspiration and no thirst. 

Worse in the evening, and at night; also when eating or drink- 
ing, or beginning to exercise. 

Better from continued exercise. 

CarDO veg. Sensitiveness and irritability; burning and press- 
ing in the eyes; pulsations in the ears; great paleness of the face , 
swollen face and lips; greenish color of the face; excessive thirst; 
numbness of the limbs (and parts affected) ; burning pain ; pulse 
small, weak, imperceptible; uneven or intermitting pulse. 

Worse in the morning and forenoon ; also in the open air, from 
poultices and pressure. 

Better after lying down. 

Causticiim. Melancholy, peevish, low-spirited; buzzing and 
roaring in the ears and head; painful swelling of the external ear; 
yellowness of the face, especially the temples; spasmodic sensa- 
tion in the lips ; sensation of tightness and pain in the jaws, 
making it very difficult to open the mouth or to eat ; violent thirst 
for cold drinks ; pulse only accelerated towards evening; flushes 
of heat ; sensation of internal chilliness, followed by perspiration 
without previous heat ; perspiration is sour. 

Worse in the evening ; also in the open air. 



328 Surgical Diseases of the Nerves, 

Better from heat. 

Chamomilla. Ill-humor, taciturn ; aversion to a bright light ; 
sensitive hearing and smell; bloatedness of the face; swelling, 
with hardness and blueness of one cheek; heat of the face while 
the rest of the body is cool ; great thirst, with longing for cold 
water; great prostrating debility as soon as the pain begins; pulse 
small, tense, and accelerated; heat, with occasional chills; heat, 
with anxiety, and perspiration of the face and scalp. 

Worse at night ; also while down, and during sweat. 

Better while fasting, and on rising. Left side. 

China Off. Indifference and apathy; serous irritation; hum- 
ming in the ears ; heat and redness of the nose ; violent thirst for 
cold water; drinks often, but very little at a time; face pale and 
sunken ; red and bloated face ; the lips are swollen ; pulse small, 
hard, and rapid, or irregular; over-sensitiveness of the nerves 
from loss of fluids. 

Worse at night ; also from the slightest touch, after drinking. 

Better in the room. 

Cicuta VIP. Hardness of hearing ; deadly paleness of the face, 
with coldness of the face and hands ; red face ; grinding of the 
teeth ; the throat feels closed ; inability to swallow ; violent thirst ; 
spasms of the muscles, especially of the neck and chest ; pulse is 
weak, slow, and trembling; internal heat. 

Worse in the afternoon ; also from cold. 

Better when in bed, and from warmth. 

Cimicifllga, (Hale.) Severe pain in left jaw; heat on one 
side of face, with lassitude all over ; very severe pain in the face, 
more in under jaw, lower teeth, and articulation of lower jaw; 
pains in head and face constant, and very severe ; pain in right 
superior maxillary bone and teeth. 

Cilia. Disposition to be offended by trifling jests ; bloated, pale 
face, with blueness around the mouth ; pale, cold face, with cold 
perspiration; increased thirst; the body is stretched out, and 
becomes rigid; dull stitches in different parts of the body; the 
limbs twitch, and are distorted ; pulse small, hard, and rapid. 

Worse at night ; also from external pressure. 

Better after lying down. Left side. 

CoCClllllS. Pain in the eyes, as if they were torn out of the 
head ; hardness of hearing, with noise as of rushing water ; heat 
in the face, and redness of the cheeks ; sensation of extreme 



Special Therapeutics. 329 

weakness ; disposition to tremble ; trembling of all the limbs ; 
pulse small and spasmodic, sometimes it cannot be felt ; perspira- 
tion of the parts affected. 

Worse in the evening ; also from talking, sleeping, drinking, and 
in the cold air. 

Better from pressure and warmth. 

Coflfea. Over-sensitiveness ; weeping mood ; sense of hearing 
more acute; dry heat in the face, with red cheeks; nightly thirst; 
the pains are intense, driving to despair ; twitching of the limbs ; 
chilliness increased by every movement ; head feels contracted 
and too small. 

Worse at night; also from the open air. 

Better from cold water. 

ColOCytlth. Aversion to talk; disinclined to answer questions; 
pulsation and rushing in the ears ; fluent coryza ; face pale and 
relaxed, with sunken eyes ; dark redness of the face ; tearing, or 
burning, or stinging pain on the left side, extending to the ear and 
head ; swelling of the face, with redness and heat of one cheek ; 
twitching of the muscles ; faintness with coldness of the extremi- 
ties ; burning pains ; pulse full, hard, and accelerated ; internal 
heat ; attacks of flushes of heat. 

Worse in afternoon and evening; also when lying down, and 
lying on painless side. 

Better when lying on painful side, and from motion. 

Conium mac. Inclination to start as if with fright ; great and 
painful sensitiveness of hearing; roaring and humming in both 
ears ; excessively acute smell ; heat in the face ; stinging-tearing 
faceache ; dry and scaly lips ; sensation of debility ; sudden loss 
of strength when walking ; pulse irregular, generally slow and full, 
alternating with small and frequent beats. 

Worse in the morning and night ; also when eating, standing, or 
at rest. 

Better from motion. Right side. 

Cypripedilim. (Hale.) This author makes the following char- 
acteristic remark : " In many cases of neuralgia ' the pain is the 
disease.' In such instances the Cypripedium will be found curative 
in many cases " ! ! ! 

Digitalis. Great anxiety, and inclination to shed tears ; gloomy 
and peevish; blueness of the eyelids; swelling of the lower lids; 
hissing before the ears, like boiling water, with hardness of hear- 



330 Surgical Diseases of the Nerves. 

ing ; pale face, with blueish hue under the pale skin ; convulsions 
on the left side of the face ; faintness and debility with perspira- 
tion ; great nervous weakness ; pulse is very slow, especially when 
at rest; pulse irregular and intermitting; while moving about the 
pulse is accelerated ; internal chilliness with external heat ; chilli- 
ness with heat and redness of the face ; sudden flushes of heat, 
followed by great debility. 

Worse after dinner. 

Better when lying down. 

Elaterium. Depression of spirits , fever with violent tearing 
pain throughout the head. 

Better from perspiration. 

Euphrasia. Taciturn, disinclined to talk; swelling of the lower 
eyelids ; redness of the face ; stitches and stiffness in the cheek 
and lower jaw when talking or chewing ; crawling as of a fly in one 
or other of the limbs, from below upwards in a straight line, with 
numbness of the part. 

Worse in the evening ; also when wet. Left side. 

Ferrum. Anxiety, as after committing a crime ; quarrelsome 
disposition ; inflammation and redness of the eyes, with burning 
and stinging ; pale bloated face, especially around the eyes ; fiery 
redness of the face, the veins are enlarged ; pale face with red 
spots ; unquenchable thirst ; longing for acids ; weakness of the 
body almost paralytic ; so weak that she must lie down ; pulse full 
and hard ; violent ebullitions. 

Worse in the morning ; also when at rest 

Better from slow exercise. Left side. 

Gelseminum. Great irritability, does not wish to be spoken to; 
aversion to light, particularly candle-light ; heat in face, with ful- 
ness in head, and cold feet ; stiffness of the jaws — they are locked ; 
pulse slow, accelerated by motion. 

Worse at night ; also on waking. 

Graphites. Melancholy, with inclination to grief; easily 
vexed ; pressure and stinging in the eyes, with lachrymation ; 
feeling as if the ear was filled with water ; pale, yellow color of 
face ; continued feeling as if from a cobweb over the face ; vio- 
lent thirst, early in the morning ; pulsation through the whole 
body whenever he moves ; pulse full and hard, but not accelera- 
ted ; inability to perspire. 

Worse at night ; also from cold. 



Special Therapeutics. 331 

Better from warmth, and on getting warm in bed. 

Gratiola. Serious, taciturn, absorbed in reverie ; burning heat 
in the face ; face feels swollen : violent thirst ; physical and men- 
tal depression ; great languor and prostration ; tetanic spasms, 
feeling bruised on recovery. 

Worse in the afternoon; also when sitting, and after eating. 

Better from contact. 

Hepar SUlph. The slightest cause irritates him, and makes 
him vehement; dejected, sad, with inclination to shed tears; in- 
flammation of the eyes and lids ; darting pains in the ears ; red- 
ness and heat of the nose; heat and fiery redness of the face; 
yellow color of the face, with blue borders around the eyes ; faint- 
ing from slight pain ; weakness of all the limbs, they feel bruised ; 
pulse full, hard, and accelerated, at times intermittent ; flushes of 
heat, with perspiration. 

Worse at night ; also from cold, and on touching the parts. 

Better from warmth. , 

HyOSCyamUS. Red, sparkling eyes ; heat and redness of the 
face ; swollen, brown-red face ; distorted bluish face, with the 
mouth wide open ; repeated attacks of fainting ; subsultus tendi- 
num ; pulse full, hard, and accelerated ; distension of the arteries ; 
cold, sour-smelling perspiration. 

Worse in the evening ; also after eating or drinking. 

Better by stooping. 

Hypericum perf. Sensation as if the head became elongated ; 
stitches in the right eye ; shooting through the ear; the face feels 
hot and bloated ; tension in the cheek ; thirst, with feeling of heat 
in the mouth ; violent thirst ; feeling of weakness and trembling 
in all the limbs ; pulse hard and accelerated. 
• Worse in the afternoon ; also after eating. {Vide Lippe, p. 294, 
symp. 39, for lacerated wounds of nerves especially.) 

Ignatia. The slightest contradiction irritates ; intolerance of 
noise ; cannot bear the glare of light ; alternate redness and pale- 
ness of the face ; redness and heat of one cheek and ear ; perspira- 
tion only on face ; trembling of the limbs ; pulse hard, full, and 
frequent, or very variable ; flushes of heat externally. 

Worse in the morning and evening ; also when lying down, 
from coffee, tobacco, and brandy. 

Better when lying on the back, and from a change of position. 

Ipecacuanha. Irritability, restlessness, impatience ; cannot 



33 2 Surgical Diseases of the Nerves. 

bear the least noise ; pale face, with blue margins around the eyes; 
convulsive twitches in the muscles of the face and lips ; opistho- 
tonos, and emprosthotonos ; great weakness, and aversion to all 
food ; over-sensitiveness to heat and cold ; twitching in the limbs ; 
the body is stretched out stiff; pulse very frequent, but at times 
scarcely perceptible ; damp coldness of the hands and feet. 

Worse at night. Right side. 

Kali Carb. Angry .and irritable ; easily startled, especially if 
touched ; painful sensitiveness of the eyes to the light of day ; 
dullness of hearing ; dullness of smell ; face bloated ; yellow color 
of the face ; swelling and redness of the cheeks ; twitching of the 
muscles ; pulse very variable ; strong pulsations in the arteries ; 
internal heat, with external chilliness ; the perspiration is fetid, or 
smells sour. 

Worse in the morning ; also in cold air, and when lying on the 
side. 

Better from warmth. 

Kali bich. Ill-humor, low-spirited, indifferent ; sudden attacks 
of giddiness on rising from the seat; eyelids burning, inflamed, 
and much swollen ; cedematous swelling of the eyelids ; sensitive 
painfulness of the bones of the face, as if bruised ; perspiration on 
the upper lip ; increased thirst ; stiffness of the neck when bend- 
ing the head forward ; quickly moving, wandering pains, from one 
part of the body to the other; great debility, with desire to lie 
down ; pulse small and accelerated ; hot, dry skin. 

Worse in the morning, and periodically ; also from cold, and 
after eating. 

Better from warmth. 

Kalmia lat. Sensation of stiffness around the eyes, and in the 
lids ; coryza, with increased sense of smell ; paleness of the face ; 
stitches and tearing in the lower jaw ; pulse slow and weak ; heat, 
with burning and pain in the back and loins ; cold perspira- 
tion ; dry skin. 

Worse in the evening ; also in the open air, and from motion. 

Better when lying down. 

LacheSJS. Nervous irritability ; paleness, yellowness, or lead- 
like color of the face ; heat and redness of the otherwise pale 
face ; great thirst ; stiffness of the neck ; tearing, pricking, and 
pulsating pains ; inclination to lie down, and aversion to move ; 
pulse small and weak, but accelerated, or else unequal and in- 



Special Therapeutics. 333 

termittent, or alternately full and small pulse; skin of the part 
bluish-red. 

Worse in the evening; also in the open air, from cold, and 
after sleep. 

Better from warmth. Right side. 

LyCOpodilim. Low-spirited, taciturn, melancholy; over sensi- 
tiveness of hearing ; the same in regard to smell ; paleness of the 
face; flushes of heat in the face; spasmodic twitching in the 
muscles of the face ; the lower jaw hangs down ; painful stiffness 
and soreness of one side of the neck ; involuntary alternate con- 
traction and extension of the muscles in different parts of the 
body ; sensation as if the circulation stood still ; want of natural 
heat; violent perspiration from the least exertion. 

Worse in the evening ; also when lying down, from the pres- 
f. ure of the clothes, and strong smells. 

Better from cold. Right side. 

Magnesia Carb. Anxious, with perspiration all day ; sad 
mood, with indisposition to talk ; sensitiveness to noise ; pale 
face ; earthy, sickly complexion ; alternate redness and paleness 
of the face ; desire for acid drinks ; stiffness of the neck ; pain- 
fulness of the whole body; pulse slightly accelerated during the 
night. 

Worse at night ; also from talking, or mental emotion. 

Better. — Symptoms are better from walking, which come on 
while sitting, and vice versa. 

Ma rig a num. Out of humor, low-spirited, and reflective ; eye- 
lids swollen, and painful to the touch ; face pale and sunken ; 
twitching stitches from lower jaws to temples when laughing ; 
cramping pain in the upper and lower jaw after eating ; no thirst ; 
stiffness of the nape of the neck ; pulse very uneven and irregu- 
lar; sudden flushes of heat in the face, chest, and over the back; 
profuse perspiration, with short, anxious breathing. 

Worse at night ; also on stooping, and on being touched ever 
so lightly. 

Better. — Symptoms better in the open air, which came on in the 
room, and vice versa. 

MerCUrillS. Copious perspirations, which do not afford any re- 
lief ; sweat at every motion ; violent thirst ; swelling, redness and 
closing of the eyelids; feverish heat and redness of the face; 
swelling of the cheeks; almost complete immobility of the jaw; 



334 Surgical Diseases of the Nerves. 

swollen and stiff neck, with difficulty of turning the head ; pain- 
ful closing of the jaws. 

Worse in the evening and night ; also from the heat of the bed, 
and when exercising. 

Better when at rest, and when lying down. 

Mezereum. Restlessness when alone, and longing for com- 
pany ; twitching of the muscles around the eyes ; visible twitching 
on the root of the nose ; gray, earthy complexion ; frequent 
troublesome twitching of the muscles in the middle of the cheek ; 
face and forehead hot and red, with great restlessness and peevish- 
ness ; tension of the muscles ; twitching of muscles ; pulse full 
and hard, in the evening accelerated ; sensitive to touch. 

Worse in the evening, and at night ; also from contact and 
motion. 

Better when walking in the open air. 

MoschllS. Great anxiety, with palpitation of the heart; ver- 
tigo as soon as the head is moved ; pale face, with perspiration ; 
the right cheek is red without heat, the left pale and hot ; heat 
in the face without redness ; tension in the facial muscles as if 
too short ; movement in the lower jaw as if he were chewing ; 
great dryness of the mouth ; pulse full and accelerated, with ebul- 
litions, or weak pulse. 

Worse in the afternoon ; also in cold air. 

Better from warmth. 

Natrum mur. Great tendency to start ; difficulty of thinking ; 
face shining, as if greasy ; heat in the face ; swollen face ; ting- 
ling and numbness of the lips; tension and drawing in the back; 
stitches in the neck and back part of the head ; painful stiffness 
of the neck; twitching in the muscles and the limbs; pulse very 
irregular ; beating of heart shakes the whole body. 

Worse in the morning ; also from physical exertion. 

Better when fasting, and after lying down. 

Nitric acid. Sadness, despondency; vexed at trifles; eyes 
dull and sunken, with pale face ; swelling of the cheeks ; violent 
thirst ; stitches in and between the shoulder-blades, with stiffness 
of the neck ; flushes of heat, with perspiration on the hands ; 
pulse very irregular, one normal beat often is followed by two 
small and rapid beats, the fourth beat entirely intermitting ; al- 
ternate hard, rapid, and small beats. 

Worse in the evening, and at night ; also on waking, and from 
touch. 



Special Therapeutics. 335 

Better from warmth. 

NlIX VOITl. Over-sensitiveness to external impressions, such as 
noise, light, and smell ; reeling vertigo on rising from a seat or 
the bed, or on raising the head ; yellowness around the mouth and 
nose, or around the eyes ; red, swollen face ; burning redness of 
the face, with heat; the muscles of the face twitch in the evening 
when lying down ; trismus ; longing for brandy, but aversion to 
water ; tension between the shoulder-blades ; sensation in the 
small of the back, as if lame ; heaviness and stiffness of the neck ; 
stitches in jerks through the whole body ; pulse full, hard, and 
accelerated, or small and rapid, or every fourth beat intermits ; 
general internal heat. 

Worse in the morning ; also from motion and slight touch, on 
waking in the morning, and after eating. 

Better from strong pressure. Right side. 

Oleander. Absence of mind, want of attention; vertigo on 
rising from the bed, or on looking fixedly at an object, or when 
looking down when standing ; alternate paleness and dark redness 
of the face ; numbness of the upper lip ; much thirst, especially 
for cold water; fainting as if from weakness, relieved by per- 
spiration ; pulse very changeable and irregular. 

Worse at night ; also when rising from the bed, and when eat- 
ing. 

Better when lying down, and from perspiration 

Opium. Stupid indifference; stupefying vertigo, compelling 
one to lie down ; the eyes are half open and turned upwards ; 
swelling of the lower lids ; the eye feels too large for the orbits ; 
the face is bloated, dark-red, and hot; bluish face; trembling, 
twitching, and spasmodic movements of the muscles of the face ; 
corners of the mouth twitch ; distortion of the mouth ; hanging 
down of the lower jaw ; the veins of the face are distended ; vio- 
lent thirst ; the body is spasmodically bent backwards ; rigidity of 
the whole body ; pulse varies very much ; heat with damp skin. 

Worse at night ; also on rising, during and after sleep. 

Better from moving. 

Petroleum. Excited, irritable, with inclination to anger ; yel- 
low complexion ; twitching in the limbs ; great debility, with 
trembling; pulse full, and accelerated from every motion ; flushes 
of heat. • 

Worse in the morning and evening. 



336 Surgical Diseases of the Nerves, 

Better from warmth. Right side. 

Phosphorus. Great excitability, easily vexed and angry ; pale, 
hypocratic countenance ; the color of the face is very change- 
able ; bloated face, puffiness under the eyes ; eyes are sunken, 
with a blue ring around them ; thirst; stiffness in the neck ; over- 
sensitiveness of all the senses ; ebullitions and congestions ; pulse 
generally accelerated. 

Worse in the evening, and at night ; also when alone, and from 
strong smells. 

Better in the dark, from rubbing, and after sleeping. 

Phytolacca. Great indifference ; shooting pain from left eye 
to vertex ; vertigo and dimness of vision ; pale face ; the pains are 
pressing, shooting, and sore. 

Platina. Low-spirited, inclined to tears, great indifference; 
spasmodic twitching and trembling of the eyelids ; redness and 
burning heat in the face, with violent thirst towards evening ; sen- 
sation of coldness, tingling, and numbness in the face ; pale, 
sunken countenance ; thirstlessness ; stiffness of the neck ; weak- 
ness, tension, and numbness in the neck ; pulse small, feeble, fre- 
quently it is tremulous ; objects appear smaller than they really 
are. 

Worse in the evening ; also when at rest. 

Better during motion. 

Pulsatilla. Peevishness, which increases to tears, with chilli- 
ness and thirstlessness ; vertigo, as if intoxicated, when rising from 
the seat, when stooping, or when lifting up the eyes ; swelling and 
redness of the eyelids ; alternate redness and paleness of the face ; 
face bloated, purple ; painful sensitiveness of the skin of the face ; 
stitches in the small of the back ; burning-stinging pains ; pulsa- 
tion through the whole body ; fainting, with great paleness of the 
face ; pulse weak and small, but accelerated. 

Worse in the evening ; also from warmth, and being in a warm 
room. 

Better from cold, and in the open air. Right side. 

Rhus tox. Restlessness which does not permit one to be quiet, 
and compels him to toss about in bed ; swelling of the eyelids ; 
aversion to light ; face pale and sunken, with blue rings around 
the eyes, and pointed nose ; stiffness in the articulations of the 
jaws ; thirst ; inflammatory swellings ; pulse irregular, generally 
faster, but weak. 



Special Therapeutics. 337 

Worse in the morning, and at night : also when beginning to 
move, when at rest, and from cold. 

Better from motion and warmth. Right side. 

Rhus rad. Excessive debility; restless nights; pulse fre- 
quent and small ; confusion of the head ; redness and swelling 
of the eyelids, with itching and burning ; burning in the face, 
with redness and itching ; vesicles on the face ; thirst at night ; 
pain and rigidity in the posterior lumbar region ; muscles of the 
neck pained by movement, and sensitive to pressure. 

Worse when beginning to move. 

Better when walking in the open air. When the Rhus tox 
fails to cure, although well indicated, I advise the use of this 
variety. 

Rllta grav. Anxious and low-spirited; inclination to quarrel 
and contradict ; great heat in the head, with much restlessness ; 
spasms of the lower eyelids ; violent thirst in the afternoon ; 
pulse only accelerated during the fever; heat in the face, with 
red cheeks, and cold hands and feet. 

Worse in the afternoon; also in cold weather, when sitting, 
during rest. 

Better from motion. Left side. 

Sabadilla. Anxious restlessness, startled by noise; burning 
heat and redness of the face ; great debility, with relaxation or 
heaviness of the body ; pulse small and spasmodic. 

Worse in the forenoon, and at night ; also from cold. 

Better from warmth. 

Secale. Great anxiety ; distortion of the eyes ; dark-redness 
of the face ; spasmodic distortion of the mouth and lips ; violent, 
unquenchable thirst; convulsive twitching in the limbs; pulse 
unchanged, even in the most violent attacks ; violent, and long- 
tinued dry heat, with great restlessness and violent thirst. 

Worse at night ; also from warmth, touch, and motion. 

Better from cold, and rubbing. Right side. 

Sepia. Sadness, with weeping ; anxiety, with flushes of heat ; 
neuralgic pains from abuse of tobacco ; swelling of the upper 
lip; stiffness in the small of the back and neck; pulsations in 
the small of the back ; inflammatory swelling ; vibrations like 
dull tingling in the body ; the pulse is full and quick, accelerated 
by motion and anger ; pulsation in all the blood vessels. 

23 



/ 



338 Surgical Diseases of the Nerves. 

Worse in the forenoon and evening ; also from mental emotions, 
when at rest, and after eating. 

Better from warm air, and violent exercise. 

Silicea. Pale, earth-colored face ; jaws spasmodically closed ; 
spasmodic pain in the small of the back, which does not allow 
one to rise ; twitching of the limbs day and night ; pulse small, 
hard, and rapid ; the circulation is easily excited ; perspiration 
only on the head. . 

Worse in the night ; also in the open air, from cold, and pres- 
sure 

Better from warmth. Right side. 

Spiyelia. Difficulty of thinking, and disinclination to mental 
exertion ; giddiness when looking downwards ; vertigo with nau- 
sea ; sensation as if the eyes were too large ; pale, bloated, and 
distorted face ; perspiration on the face ; periodical face-ache ; 
pains, burning, and tension, especially in the cheek-bones, above 
the eyebrows, in the eyeball, and in the left side ; violent thirst ; 
pulse irregular, generally strong, but slow ; trembling pulse ; cold 
perspiration. 

Worse in the forenoon, and at night ; also from noise, move- 
ment, touch, and stooping. 

Better after lying down. Left side. 

Stan num. Great anxiety and restlessness; vertigo; it seems 
as if all objects were too far off; burning-stitches in the eyelids; 
pale, sunken face, with deep-sunken eyes ; pulse small and quick ; 
anxious sensation of heat from the least movement ; pains which 
increase gradually to the maximum, and then gradually decrease. 

Worse in the evening ; also after moving, and from talking. 

Better from loosening the garments, and when lying on the 
back. Left side. 

Staph asayria. Weakness of memory ; countenance sunken, 
with sunken eyes, and peaked nose; blue margins around the 
eyes ; violent upward stitches in the back ; twitches at night ; 
pulse very fast, but small and trembling. 

Worse. — About the same all times of day, except 

Better in evening. Right side. 

Strammonium. Very changeable disposition; red, inflamed, 
swollen eyes ; contortion of the eyes and eyelids ; red, swollen, 
and turgid face ; stupid, distorted countenance ; anxiety and fear 
is expressed in the countenance ; distortion of the mouth ; vio 



Special Therapeutics, 339 

lent thirst, drinking large quantities ; body bent backwards, with 
distorted countenance ; pulse very irregular, generally small, hard, 
and quick ; hot, red face, with cold hands and feet. 

Worse in the morning ; also after sleep, from touch, and when 
alone. 

Better from bright light. 

Sulphur. Peevish and irritable ; face pale ; circumscribed red 
spots on the face ; red blotches on face ; sunken eyes, with blue 
margins ; trembling and twitching of the lips ; cold perspiration 
on the face ; constant thirst ; stiffness in the neck ; drawing in the 
back ; pain in the small of the back, not permitting one to stand 
erect ; great debility and trembling, talking fatigues ; pulse full, 
hard, and quick, at times intermitting ; swollen veins ; cold nose, 
hands, and feet ; dry heat, with thirst ; flushes of heat ; perspira- 
tion easily excited, or want of perspiration. 

Worse in the evening ; also on waking, or getting warm in bed, 
from bodily exertion, talking, when at rest, and from being 
touched. 

Better from motion. Left side. 

Teucrium. Great sensitiveness and excitability; pale face; 
frequent feeling of flushes of heat, without redness ; nervous ex- 
citability ; trembling sensation in the whole body. 

Worse in the forenoon, and at night ; also on stooping, and to 
the touch. Right side. 

Thuja. Over-excited ; becomes angry at trifles ; vertigo on 
closing the eyes, disappears on opening them ; heat and redness 
of the whole face, with fine nets of veins, looking as if marbled ; 
circumscribed burning redness of the cheeks ; greasy skin of the 
face ; swelling of the temporal arteries ; neuralgia, originating in 
the left cheekbone, near the ear, extending through the teeth to 
the nose, through the eyes into the temples, and into the head, 
the painful places burn like fire, and are very sensitive to the 
rays of the sun ; violent thirst ; beating and pulsating in the back ; 
jerking in the upper part of the body ; pulse in the morning slow 
and weak, in the evening accelerated and full ; in the evenings, 
violent pulsation ; swelling of the veins. 

Worse in the morning, evening, and at night ; also from cold- 
wet and the heat of the bed. 

Better from warm-wet, and on turning from the left to the 
right side. 



340 Surgical Diseases of the Nerves. 

Valerian. Very changeable disposition: redness and heat of 
the cheeks, especially in the open air ; over-sensitiveness of all 
the senses ; pulse irregular. 

Worse in the forenoon, and towards evening ; also while repos- 
ing, when standing, and in the sun. 

Better in the light, and from motion. 

Veratrum. Vertigo, with cold head; perspiration on the fore- 
head ; face pale, bluish, cold, disfigured like death ; blue or green 
circles around the eyes ; spasms of muscles when masticating ; 
violent, unquenchable thirst, particularly for cold water; back 
and small of the back feel sore and bruised ; sudden sinking of 
strength ; shocks in the limbs, as from electricity ; spasms, with 
convulsive motions of the limbs ; tetanic stiffness of the body ; 
pulse irregular, generally small and thread-like, and weak ; slow 
pulse, often it cannot be felt at all ; perspire easily from the least 
exertion. 

Worse in the morning; also after sleep, and during perspira- 
tion. 

Better after perspiration. 

Vipera Redl. Opisthotonos; cold sweat; restlessness; frequent 
vertigo ; protruded eyes ; face swollen ; oppression of chest. 

Zincum, Very variable mood ; paleness of the face; stiffness 
and tension of the neck; pulsations through the whole body; 
violent trembling, twitching of the body; pulse small and rapid 
in the evening, slower in the morning and during the day ; pulse 
at times intermitting ; violent pulsations in the veins ; flushes of 
heat, with trembling, and short, hot breath ; badly-smelling per- 
spiration ; perspire easily during the day, and on exercising. 

Worse in the afternoon and evening ; also after eating, and in 
the warm room. 

Better in the open air. 



Suppuration, 341 



SUPPURATION. 
ABSCESSES, SINUS, FISTULA. 

Suppuration. 

Suppuration is the termination of inflammation by the forma- 
tion of pus. This change is known by the chills, remission total 
or partial, of a hitherto sharp and acute pain, followed by a dull 
one, with throbbing or pulsation ; there is also a sense of weight 
in the part, and finally, fluctuation; that is, if pressure be made 
lightly with the finger on one side of the tumor, and a finger be 
placed at the opposite, if there be fluid contents, a sense of fluctu- 
ation will be felt; similar to what a mass of fluid would be 
supposed to make. So many tumors with fluid contents present 
themselves, that it is of the utmost importance that a correct diag- 
nosis should be made. This test by fluctuation reveals fluid only ; 
now it may be blood, water, or some other secretion. The best 
test is, the use of an exploring needle. Of late we have a delicate 
trocar and canula, for this purpose, made small enough to carry 
in the pocket case, and it is an instrument that will prove very 
useful in many other cases. 

If pus is present, what shall we do ? 

1st. In nearly every variety of suppuration, there is but little 
probability of the pus being absorbed. The cold or chronic abscess 
is the only one that I believe to be an exception. Pus cannot be 
absorbed without doing the patient more or less injury. 

2nd. "Nature finds an outlet for it." — Granted. Suppose we 
have an abscess in a prominent part, on the face, particularly if 
the patient be a lady ; scarring of the worst kind is almost inevit- 
able if it be allowed to discharge itself spontaneously. If a 
person applies to us with a whitlow on the finger, we give remedies 
to hasten this suppurative process, if it has commenced. It opens 
itself and the bone necroses and exfoliates. What have we 
achieved by not at once opening it, and thereby preventing all 



34 2 Abscesses, 

that mischief? This is an every-day occurrence, and not " far- 
fetched." If it is the infliction of pain that is dreaded, how much 
more pain does the patient suffer when going about for days in 
that condition ? Suppose medicine does remove a felon in a week, 
what is gained? an early opening before pus has formed, will cause 
but a moment's pain, and cures it in twenty-four hours. If pus 
has formed, we save the bone. 

yd. The imprisoned matter, if unable to make a ready exit, 
will burrow in all directions, dissecting and destroying all the parts, 
until some point is reached where the tissues are not so dense. 
Psoas abscesses have been known to point under the tendo Achilles. 
How much better, as the pus has got to come out, to have let it out 
as soon as it showed itself in the groin. 

4th. The danger apprehended by many of inflammation of the 
sac from the admission of air, is not without foundation ; but there 
is no reason why this admission should take place. Open it under 
water, by a valvular incision, and then if inflammation follows, 
Calend. or Aeon, will make all right Pus is just as much a foreign 
material as is a splinter in the finger, and no man gives medicine 
to remove that. Nature is a bad physician ! some there are who 
tell us that in following her leading we do right. Hahnemann 
says we do wrong. In the " Organon" page 42, he says — "The 
ordinary school of medicine regarded the means which the organ- 
ism employs to relieve itself, in those patients who make no use 
of medicine, as perfect models for imitation ; but they were greatly 
mistaken. The miserable and very imperfect attempts which the 
vital powers make to assist themselves in acute diseases, is a spec- 
tacle that ought to excite man to use all the resources of his 
wisdom and learning to put an end, by a real cure, to this torment 
which nature herself inflicts." Perhaps I have said too much 
already on this subject, but as it is one that has excited almost as 
much controversy as high and low dilutions, it is one of much 
interest to us all. 

The majority consider pus an alteration due to some existing 
disease of normal secretions. Erichsen holds to this belief, and 
says of it, " pus-cells have been shown by recent observers to be 
modified or degenerated exudation corpuscles, and the fluid in 
which they float, to be of a serous character." Paget practically 
demonstrates the same theory. According to Conheim, they are 
white blood-cells. Pus forming on a free surface is called &puru- 



Abscess. 343 

lent secretion, and when in deeper structures, an abscess. In 
whatever situation it occurs, it presents pretty much the same 
general characters. Pure pus we call laudable or healthy ; when 
mixed with blood, grumous ; when acrid or corroding, or thin and 
watery, the word used as designating the appearance, is applied 
to them as a name. These last varieties are commonly mixed 
with the debris of bone, muscular tissue, etc. 

Abscess. 

Abscess is a term applied to a collection of pus in any cavity of 
the body, or in the substance of a part. A part becomes inflamed 
and tender, subsequently indurated, and with a feeling of weight. 
A chill, more or less severe, according to the extent of the injury, 
follows, with a remission of pain, followed by a beating and throb- 
bing, which is also followed by softening of the tumor, without 
any diminution in bulk, and as the disease progresses palpation 
or the trocar will reveal the character of the fluid, whether pus or 
not. From the great distension of the skin, and consequent pres- 
sure exerted upon it, that part which is the weakest, will event- 
ually give way, and an outlet being thus formed, the exertion of 
proper care will readily conduct it to a successful termination. 
One point on the body of the swelling will be noticed to be a 
little elevated above the surrounding skin, and gradually losing 
its red color, will take on a yellowish-white one. This we call 
" pointing," and it indicates the position of the opening. These 
symptoms constitute what we call the acute abscess, which is a type 
of all the others. On examining carefully the cavity, emptied of 
its contents, we find a limiting membrane lining it throughout, 
formed of lymph, which is called the pyogenic membrane; this 
Delpech thought to be the secreting membrane of pus, and many, 
I fear, still hold to that belief. The extension of an abscess 
beyond these original limits, I suppose, is owing to an imperfect 
formation of this membrane, or the extension of the primary 
inflammation beyond it. 

Chronic abscess differs from the others, as it is more insidious 
during its formative existence ; slower in its course, little or no 
pain, and no discoloration of the integuments. They are very apt 
to remain stationary for years, and sometimes never discharge, but 
gradually become reabsorbed. A close observance of the patient 



344 Abscesses. 

will, however, show that the health is gradually giving way, and 
death will in most cases follow unless relief be speedily afforded. 
This variety is the one above all others we are told not to open. 
Now can any sane man believe or teach that the patient derives 
any actual benefit from this disease ? What danger do we run in 
opening it, that our remedies cannot probably arrest ? I say open 
them. The pus is usually laudable, though I have seen cases in 
which it was flaky and curdled. Absorption of such pus must be 
followed by injurious results. 

Cold abscess is also known as lymphatic, though I do not recognize 
any distinction between them and the chronic. It occurs with but 
few if any premonitory symptoms, and usually unaccompanied by 
pain at any time. Cachectic individuals, scrofulous principally, 
are particularly prone to it, and the first intimation they have of 
it, is a large, fluctuating tumor appearing suddenly in the groin, 
axilla, or iliac fossa. The contained fluid is thin, purulent, offen- 
sive matter. Again, I say, open early. 

Diffused abscesses are such as occur in the cellular tissue, after 
erysipelas or inflammation, and extend rapidly in all directions, 
forming sinuses, and burrowing to a great extent. I doubt 
whether the pyogenic membrane be fully formed in these cases, 
indeed if it is formed at all. Probably the transformation of the 
lymph is so rapid that but little time is given it for even the 
imperfect organization requisite. 

The tympanitic or emphysematous abscesses, are those sometimes 
found in. the mucous passages, more frequently in the abdomen, 
and take their name from the fact of their being partly filled with 
gas, and partly with pus. 



Sinus and Fistula. 

As the results of suppuration, we have the formation of sinus 
and fistula. 

Sinus is a term used synonomously with fistula by many, but I 
consider it faulty. By sinus I understand a track leading from an 
abscess, burrowing in different directions, and not communicating 
with the air ; as in erysipelas, which has produced suppuration, 
we find long tracks leading off for some distance. These sinuses 
may result in fistula, when from some reason they do not heal, 



Sinus and Fistula. 345 

and eventually open through the skin, or into some organ or 
cavity. 

Fistula is a canal leading from the skin into the abscess. From 
some cause, the abscess after opening, either by the knife or spon- 
taneously, sometimes refuses to close up ; this cause may be the 
presence of a foreign body, as a piece of bone, or bullet, or the 
constant passage of irritating discharges, saliva flowing through a 
wound in the cheek will produce salivary fistula. Whatever the 
cause may be, a canal is formed, permanently open, which event- 
ually has the sides converted into fibrous material, and is a source 
of constant annoyance. 

Treatment. — In treating these diseases, one point must be 
borne in mind. When the character of the pus is bad, the remedy 
is to be given to change the character of this pus to a healthy one, 
and then it will heal naturally. Do not change the remedy if the 
quantity of pus is increased, if the color and consistency is be- 
coming correspondingly better. But if the pus is unhealthy, and 
the remedies seem to produce a total suppression, without first 
making it laudable, there is danger! Excite its reappearance by 
using poultices and Hep. s. in a very low attenuation. In treating 
sinus and fistula, in addition to the proper remedy, use constant 
pressure by judicious bandaging, or some of the modern appliances 
much in use. It may become necessary to operate. If the char- 
acter and position of the fistula will admit of it, pass a probe- 
pointed bistoury through it, and rapidly divide it, with all the 
muscles and structure in its neighborhood, taking care to avoid 
the arteries. At other times it is well, if the canal is short, and 
division will endanger vessels, to dissect out the fibrous lining 
entirely. 

The remedies in common use are : 
Abscess: Am., Ars., Baryta, Bell, Bry., Cole, c., Calend., Car bo 
v., Cham., Chin., Con., Dulc, Graph., Hep., Lye, Merc, Bhos. f 
Puis., Rhus, SiL, Spong., Sulph. 
Fistula : See Anal and Vaginal Fistula. 

Arnica montana. General sinking of strength ; pricking pains ; 
dull stitches in the part ; dull, heavy pain in the part ; hot, hard, 
and shining swelling. 

Worse in the morning, evening, and at night ; also on raising 
the part affected, on moving, from being touched, and during 
walking. 



346 Abscesses. 

Better from lying down, rubbing, and from warmth. Left side. 

Arsenicum alb. Burning in the affected part ; the skin cover- 
ing the induration is of a shining red color, or red with a tinge of 
blue ; muscular prostration, trembling, and sleepless restlessness. 
Pus copious, bloody, corroding or ichorous, watery, and of a putrid 
smell. 

Worse in the evening, and at night; also from cold, and when 
lying down. 

Better on getting warm in bed, and from Warmth in general. 
Either side. 

Baryta carb. Induration followed by suppuration of the 
glands, particularly the sub-maxillary, and the parotid; stitches in 
the part ; tingling and burning of the skin ; constant inclination 
to lie, or sit down ; great weariness. Pus scanty. 

Worse at night ; also from cold, particularly cold air, raising the 
part affected, from pressure, and while sitting. 

Better from warmth. Left side. 

Belladonna. Great sensitiveness to cold air; burning, sting- 
ing and tingling in the part ; scarlet redness, and hot swelling ; 
painful glandular swelling ; induration, followed by suppuration of 
the tonsils. Pus scanty. 

Worse in the afternoon, evening, and at night ; also from cold 
in general, on getting heated, on raising the part, from moving, 
and from wet poultices ; also from being touched, and when walk- 
ing. 

Better when lying down, or standing. Right side. 

Bryonia alba. Tense, hot, pale, or red swelling ; swelling and 
induration of the glands ; hard knots in various places, resembling 
indurated cutaneous glands ; hot, inflammatory swelling of the 
hands and feet. Pus putrid, and brownish, and yellow. 

Worse in the evening, and at night ; also from the cold air, on 
moving the part, on being touched, from walking, and on getting 
warm in the open air. 

Better from cold, when lying down, and on getting warm in 
bed. Right side. 

Calcarea Carb. The skin is painful to the touch ; in the even- 
ing when in bed there is a violent itching of the affected part; 
hot skin, with an itching, vesicular eruption ; great heat and 
thirst, with but little appetite. Pus may be either copious or 
scanty, of a putrid smell, and yellowish in color, or white and thin 
like milk. 



Special Therapeutics, 347 

Worse in the morning, and at night ; also from cold air, and 
from using poultices. 

Better on rising up and moving about, after sitting or lying some 
time. Right side. 

Calendula Off. When induration occurs after surgical opera- 
tions, followed by suppuration, the wound becomes raw and 
inflamed, is painful in the morning, as if beaten, with stinging, 
followed by throbbing, as if it would suppurate. 

CarbO Veg. Burning of the skin, with indurated, glandular 
swellings ; lymphatic swellings and abscess, with burning pain ; 
swelling, with a beating, throbbing pain ; aching in the lower part 
of the back ; throbbing pains in the hands, with swelling and in- 
flammation. Pus bloody, ichorous, or corroding, and of a yellow- 
ish color. 

Worse in the morning, and in the forenoon ; also when in the 
open air, on getting heated, from poultices, pressure, and from 
warmth. 

Better in the afternoon, and evening. Either side. 

Chamomilla Vlllg. Pain in the periosteum of the part, with a 
paralytic weakness ; hardness, and blue-redness of the skin ; swell- 
ing and induration of the parotid and sub-maxillary glands. Pus 
is corroding. 

Worse in the evening, and at night ; also in the open air, on 
lying down, when moving the part, from poultices, on being 
touched, and on getting warm in bed. 

Better from cold. Left side. 

China Off. Heaviness and emaciation ; yellowish color of the 
skin ; hard, red swellings ; stinging, pulling, and burning, or titil- 
lation in the skin ; painfulness, and excessive sensitiveness of the 
skin ; swelling of the glands of the throat, with pain during de- 
glutition ; suppuration and painful swelling of the joints, par- 
ticularly of the knee. Pus ichorous and putrid. 

Worse at night ; also in the open air, and on moving the part. 

Better, sometimes, from moving the part. Left side. 

Conilim mac. Swelling and induration of the glands; blue, or 
bluish-black color of the skin ; burning stitches ; painful burn- 
ing. Pus putrid and viscid. 

Worse in the morning, and at night ; also in the open air, from 
cold, and when standing. 

Better when moving the affected parts, from pressure, and when 
walking. Right side. 



348 Abscesses. 

Dulcamara. The parts feel heavy ; bruised feeling ; dryness, 
heat, and burning of the skin , cold tumors ; inflammation, and in- 
duration of the inguinal glands; tensive, drawing pain. Pus 
scanty and yellow. 

Worse in the evening, and at night ; also from cold, and when 
lying down. 

Better from warmth. Left side. 

Graphites. Red, hard swelling ; sensitive when touched ; scrof- 
ulous swelling ; tremor and slight twitchings in particular muscles ; 
strumous indurations. Pus corroding, watery, scanty, and very 
putrid ; smells like herring-brine. 

Worse in the fore part of the night; also on moving, while 
walking, and on getting warm in bed. 

Better from pressure, and from warmth in general. Either 
side. 

Hepar S 111 ph. Drawing pains in the limbs and joints ; lacerat- 
ing and pricking pains in the tumors ; throbbing and beating in 
the abscess; tremor, and slight twitching in particular muscles; 
the skin over the abscess is highly inflamed, hard, hot, and swell- 
ing ; suppurations and tumors, brought on by the excessive use 
of mercury ; sleepiness, dull, and drowsy. Pus scanty, bloody, 
corroding, and smelling like old cheese. 

Worse in the evening, and at night ; also from cold, on moving, 
from pressure, on being touched, and on walking. 

Better from warmth, and on getting warm in bed. Either side. 

Lycopodilim. Induration of the glands, with cramping and 
cutting ; inflammation, with a pressing pain, terminating in sup- 
puration ; tearing, tensive, jerking pains ; burning, red, or yellow 
skin. Pus bloody, corroding, and putrid, or of a whitish, milky 
appearance. 

Worse in the evening, and at night ; also from the cold air, on 
lying down, from wet poultice, from pressure, on being touched, 
and on getting warm in bed. 

Better from cold, when moving the affected part, when walking, 
and from warmth in general. Right side. 

MerClirillS SOl. Burning, redness of the skin ; pricking and 
tickling of the skin ; indurated, inflamed, swollen, and painful 
glands ; pressing from within, outwards ; pulsation, swelling of the 
glands ; hard, hot, and inflammatory glandular swellings. Pus 
copious, bloody, corroding, thin and watery, or all these charac- 
ters, but scanty. 



Special Therapeutics. 349 

Worse in the evening, and at night ; also in the cold air, from 
poultices, while walking, and on getting warm in the open air. 

Better on falling asleep, from rubbing, and while sitting. Either 
side. 

Phosphorus. Lymphatic abscesses, full of flstulae; callous 
feeling ; hectic fever. Pus copious and yellow. 

Worse in the morning, evening, and at night ; also on moving. 

Better in the open air, while standing, and from warmth. Right 
side. 

Pulsatilla. Erysipelatous swelling, hard, burning heat, and 
stinging when moving or touching the part ; blue-red swelling, 
with heat, burning, or throbbing ; painful inflammatory induration 
of the glands, with jerking and itching ; bluish, hard, and hot 
swelling, with a pricking, or sensation of tension in the parts. Pus 
bloody and copious, greenish or yellow. 

Worse in- the evening, and at night ; also on moving the part, 
from rubbing, while standing, and on being touched. 

Better in the open air, from cold, moving the part, wetting the 
part, and from the use of poultices. Right side. 

Rhus tox. Smooth, red and shining swellings; the inflamed 
skin is puffy like a bladder, or is covered with little painful white 
vesicles ; indurated glandular swellings ; swelling and suppuration 
of the eyelids ; feeling of contusion in the glands. Pus copious, 
corroding and watery. 

Worse in the evening, and at night ; also from cold, on lying 
down, from poultices, when standing, and on being touched. 

Better when moving, from pressure and from warmth. Right 
side. 

Silicea. Scrofulous engorgement and induration of the glands, 
particularly those of the neck, with or without inflammation; 
pains are either burning, cutting, itching, prickling, or pulsative ; 
hot, inflammatory swelling of the glands, either painful or painless. 
Pus is copious or scanty, and may be bloody, brownish, corroding, 
gelatinous, greenish or gray, putrid, thin and watery, or yellow. 

Worse in the forenoon, afternoon, evening, and at night ; also 
from cold, in the open air, on lifting the part, from pressure, on 
rubbing, and on being touched. Right side. 

Spongia tosta. Scrofulous engorgement and induration of the 
glands of the neck ; sensation as if air passed through them ; a 
sensation as if something living were in the glands, or a gnawing 



350 Abscesses, 

and itching ; painful pressing from within out ; also a sensation of 
swelling, tension, and titillation; dryness of the skin; with heat? 
Pus scanty. 

Worse in the night ; also when ascending an eminence, and in 
a warm room. 

Better when descending an eminence. Either side. 

Sulphur. Inflammation of the glands ; painful pressing, pul- 
sating, red, hot, and hard swellings; flashes of heat; biting and 
burning in the skin ; external coldness, perceptible to the hand ; 
crawling, pricking, itching and gnawing ; aching as if sore. Pus 
is thin and blackish, and of a sour or putrid smell. 

Worse in the evening, and at night ; also from poultices, while 
standing, being touched, and on getting warm in bed. 

Better from cold, and when rubbing. Left side. 

The operations that may be necessary in the treatment of these 
diseases are very simple. 

Sinuses are to be opened their whole length. Insert a grooved 
director, and with a probe-pointed knife, slit them up. 

Fistula may be opened in the same manner, but there is a better 
proceeding, — care must be taken, as is said in a previous para- 
graph, to avoid all arteries of a size sufficient to require ligation. 
A probe is necessary to determine the extent and character of the 
passage. To avoid inflicting unnecessary pain, an instrument 
has been devised, by which the exploration, and if necessary, the 
incision can be made with one introduction of the instrument. 
It is a probe, somewhat longer than common, one end of which 
is a knife, narrow at its junction with the probe, and rapidly 
widening to the extent of four or five inches, when it is over 
three inches broad. When the probe is introduced, if it be found 
practicable to divide the fistula, in place of withdrawing it, and 
then subjecting the patient to a fresh torture in introducing the 
director, draw the probe entirely through, by this means dividing 
the tissues with one operation 



Ulcers. 351 



ULCERS. 



Ulcers. 

Among Homceopathists (?) there are many who entertain the 
conviction that in common with the old -school, dominant no longer, 
the only rational mode of treating ulcers, is by topical applications ; 
and that the totality of symptoms in such cases, is of but little 
importance. This great error may be in part accounted for, from 
the fact that our surgical literature is very deficient in all points, 
but more especially in this one particular. An ulcer is but a local 
manifestation of a generally diseased organism : and to cure it 
radically, as well as scientifically, we are obliged to address our 
remedies to the general constitutional, as well as the local condition 
of the person under treatment. That this is the treatment to be 
pursued, my experience teaches me. Having made these cases a 
special study, I have treated and seen great numbers, and with 
the exception of some few cases in the earlier part of my practice, 
have treated them all on the strict Hahnemannian principles. 

An ulcer may be defined to be, a solution of continuity of the 
substance of the skin, and may be either idiopathic, traumatic or 
specific. 

Idiopathic ulcers are those that appear without any apparent 
cause, and are uncomplicated with any other disease. Those 
called traumatic, are such as are produced by some injury, but 
nevertheless owe their continuance to some abnormal condition of 
the system. Specific sores are those that are peculiar to such 
disease as syphilis, or struma. Erichsen considers their exist- 
ence, or rather their continuance, to be due to a faulty condition 
of the absorbents. Thus one of these conditions are concerned : 

1 st. Where deposition is normal, but absorption too active. 

2nd. Where absorption is normal and deposition deficient. 

3rd. Or, a simple detachment, or elimination of spoiled dead 
matter. 

Ulceration is always preceded by more or less inflammation, 
the intensity, character and duration of which must all be taken 



35 2 Ulcers. 

into consideration in determining which of these conditions exist. 
Paget thinks that when the inflamed part is denuded of its epithe- 
lium only, it is a simple abrasion; and ulceration consists in a 
removal of proper or vascular tissue ; thus thinking, the process 
of ulceration is an ejectment, and not depending on faulty absorp- 
tion. Erichsen's proposition that they are producible either by 
absorption or elimination, strikes me as being the best. 

Apart from the three grand divisions of these most important 
lesions we have several sub-divisions ; all of which will claim a 
few words of passing notice. With the specific ulcers, syphilitic, 
cancerous, and scorbutic, we have nothing to do now; each receives 
proper attention in its appropriate place. Of the different varie- 
ties then, we have the simple, weak, indolent, inflamed, sloughing, 
varicose, irritable and hemorrhagic ulcers. 

Simple ulcer is a type of the whole class ; and is nothing more 
than an open sore, oval or circular in form, shallow, covered with 
heathy granulations and discharging true or laudable pus. This 
form has a constant tendency to heal, and needs but little treat- 
ment. 

Weak Ulcer : This is a sore of the former variety badly treated. 
The granulations become flabby, the pus changes to a thin, watery 
fluid, or is suppressed entirely ; the edges are pale and not 
uncommonly elevated. The granulations sometimes attain an 
immense size, and look like jelly. This form, although usually 
the result of neglect on the part of the patient, or ignorance and 
bad treatment on that of the surgeon, commonly proceeds from 
the simple variety; yet sometimes they take on this character 
from the beginning. 

Inflamed Ulcer : This is also the result of too-long continued 
or badly selected use of topical stimulating treatment, and may 
occur in the treatment of either of the other varieties. The 
edges and surrounding skin in these cases are much inflamed and 
tender ; pus is thick and very offensive, often streaked with blood ; 
and though the granulations are large, they are firmer than in the 
last form. It is not, however, uncommon for the granulations to 
be entirely or nearly destroyed. 

Indolent Ulcer : These are the most obstinate affairs that can 
well be imagined, and will try the patience of the surgeon more 
than almost any other disease. These sores are chronic, and may 
be caused by bad treatment or neglect of any of the former 



Ulcers. 353 

varieties, or appear in its proper character from the first. In 
these the skin is much indurated, and appears to be firmly adher- 
ent to the bone; the surrounding integument is much discolored, 
and is often found to be scaling off, or coming away in the shape 
of little scabs, which are being constantly reproduced. They are 
not at all painful, indeed they are often without sensation of any 
kind. The edges are elevated and callous, the outline ragged and 
irregular, and the base or floor flat ; they are dry, and exude a 
bad-smelling, unhealthy sanies ; the granulations are few, irregu- 
lar in size and shape, and widely separated. These ulcers are 
commonly known as " old men's sores," and are chiefly found on 
the leg, midway between the ankle and the knee. 

Sloughing Ulcer : This is an aggravated form of the inflamed 
ulcer, and usually caused by bad treatment, though it often 
results from no treatment at all. In a previously inflamed ulcer, 
the edges become sharp-cup and discolored ; the pus changes to 
a thinner fluid, ichorous and putrid ; the base becomes grayish and 
painful ; the inflammation rapidly extends, and is accompanied 
by considerable fever ; the edges break down, and the ulcerative 
action extends rapidly. These ulcers require close watching. 

Irritable Ulcer : This is a small ulcer, confined mostly to 
women, and among them to those of a nervous or bilious temper- 
ament, and about the middle period of life. They are small; 
edges are irregular but flat, not elevated ; the surface covered with 
a tough, gray slough, and the discharge thin and acrid. They are 
very painful and exceedingly sensitive to the touch. I have seen 
just such sores produced by the excessive use of Mercury. 

Varicose Ulcer : This variety by the old school is considered 
incurable, or next to it ; by us they are not so considered, but on 
the contrary have proved to be very amenable to treatment. 
They are more readily known by the history of the case than by 
their appearance. The appearances are those of any of the other 
forms, and they may be inflamed, indolent, irritable, or sloughing, 
according to the peculiar circumstances of the case. 

Hemorrhagic Ulcer : This is a small ulcer of a purplish color, 
" and," says Erichsen, " usually occurs in women suffering from 
amenorrhcea ; " and, as its name indicates, usually oozes blood at 
the catamenial periods. It is very similar to the irritable ulcer, 
and can only be established as hemorrhagic by the elicitation of 

the above facts. 
23 



354 Ulcers, 

These are the most common varieties of ulcers, as noticed by 
authors, but the practical value of this nomenclature is not much. 
Homoeopathists, young in surgery, think old-school books our 
standard in surgical practice; and really from the want of 
homoeopathic literature on the subject, we have no where else to 
turn. This fact must be borne in mind, that because we have no 
such book, is the best reason in the world why we should throw 
over allopathy, and make them. Let not the fear of the charge ot 
presumption deter us from recording our successes, with remedies^ 
in the treatment of those diseases hitherto untouched by our 
writers ; pile up the cases until we have a complete system of our 
own. 

The causes which may produce ulceration are manifold, and 
yet I consider them only as exciting forces. Continued pressure, 
impoverished vitality, direct injury, the application of specific 
poison, all may aid in producing a simple ulcer. When the gen- 
eral system is perfectly healthy, this sore heals at once spontane- 
ously; when there is some disease one of the other varieties 
results. Many people have small sores on their body, that they 
are taught to believe are safety-vents, and when these become 
closed they feel ill. Always close such sores at once ; and if they 
heal readily under your treatment the presumption is the cure is 
radical. Closing ulcers by the topical use of astringents is like 
curing vomiting by sewing up the mouth ; or cutting out the spots 
in small- pox. An ulcer can never be called cured which has 
been closed by such measures. Therefore, an ulcer can never 
be healed until we remove the morbific cause, which is only to be 
reached by rational internal medication. Throw away all salves, 

lotions and ointments ; they do more harm than good by retard- 
ing, yes, in many cases, preventing a cure. These remarks apply 
to all the forms of ulceration, with a modified application to the 
varicose variety. These are directly caused by a rupture of a 
varicosed vein ; indirectly they are kept open, by the disease 
producing varix. 

The treatment, according to strict homoeopathic principles, 
presupposes a thorough knowledge of the law of similars, and 
demands on the part of the surgeon great care and judgment in 
selecting the proper remedy. Although topical applications are 
forbidden, strapping, and as much quiet as can be obtained, will 
aid very materially in perfecting a cure. I have succeeded 



Special Therapeutics. 355 

frequently in curing these lesions with the patient going about his 
or her accustomed occupation. Nevertheless, when practicable, 
enjoin upon them perfect quiet, and an elevated position of the 
member. The leg will be found more commonly the seat of 
these sores. 

The remedy, when selected, should be given alone, without any 
alternation and at long intervals. My custom is to use the higher 
potencies, to give but one dose ; not to be repeated until improve- 
ment ceases. When the ulcer commences healing from the centre, 
the healing process will not be continued to completion ; before 
this reaches the circumference it will break down again. Closing 
should begin from the edges. The first indications of a proper 
natural process in healing will be a flattening of the edges ; 
cessation or diminution of pain ; change of the discharge to a 
laudable pus, detachment of the slough ; firm granulations, and 
not unfrequently an itching and biting of the skin. Supposing, 
then, the sore to be on the leg: bandage the limb tolerably 
firmly, leaving the ulcer exposed ; keep the foot elevated on a 
chair, and free of pressure or irritation of any kind. If this is 
not possible, and the patient is absolutely compelled to move 
about to attend to his business, use in place of a bandage strips 
of adhesive plaster from one to two inches wide, and apply them 
obliquely, slightly overlapping each other, to the middle of the 
foot below, and as far as the knee above the ulcer, leaving the sore 
itself exposed. Avoid stimulating diet and keep the parts clean. 

Treatment. — The list of remedies I shall give is a large 
one, but it really does not embrace all that may be indicated ; 
more would probably be confusing, and so they have been cut out. 
Some few of those retained have not acted as well in my hands as 
was expected, and I have taken the liberty of adding an interroga- 
tion mark to the name. The remedies are these : 

Acid mur., Acid nit., Acid sulph., Ambra gris., Amm. c, Ammo, 
m., Ant. c, Argent, nit., Arnica mon., Ars. alb., Aur. met., Baryta c, 
Bell., Bovista, Bry., Calc. carb., Calc. phos., Canth., Car bo an., Car bo 
v., Caust., Cham., Chelid., China, Clematis, Con. mac., Cupr. acet., 
Dulc, Euphras, Eupator, Graph., Hep. s., Kali c, Kreos., Lach., 
Lye, Merc, Mezer., Natr. c, Natr. mur., Nux v. Petrol., Phos., 
Phos. ac, Pulsat., Ranunc, Rhus rad., Rhus tox., Ruta grav., 
Sabin., Secale, Sepia, Silicea, Staph., Sulph., Tartar emet., Thuja, 
Verat., Zinc. To this list, large as it is, I would add : Kali bich., 
Hama. virg., Hydrastis can., and Apis mel. 



356 Ulcers. 

Simple Ulcers: Ambrag., Amm. m., Am., Ars., Bovista, Bry., 
Calc. c, Calend., Car bo v., Caust, Chin., Clem., Con., Cuprum, 
Dulc, Hep. s., Kreos., Merc, Mezer., Natr. c, Nux v., Puis., 
Ranune, Rhus tox., Rhus rad., Ruta g., Staph., Verat. 

Weak Ulcers: Ant. e, Ars., Baryta, Calend., Carbo v., Causi. 
Cham., Chin., Con., Cuprum, Graph., Merc, Mezer., Nux v., 
Petrol., Puis., Sep., SiL, Sulph., Thuja, Zinc. 

Indolent Ulcers: Acid mur., Acid phos., Amb. gris., Ant. c, 
Am., Ars., Baryta, Bell., Bry., Calc. c, Calend., Carbo v., 
Caust., Cham., Chelid., China, Clem., Cuprum, Dulc.,Euphorb., 
Graph., Iod., Kali, Lach., Lye, Merc, Mezer., Nux v., Petrol., 
Phos., Puis., Rhus rad., Rhus tox., Sabin., Secale, Sep., Sil., 
Sulph., Thuja, Verat., Zinc 

Irritable Ulcers: Acid mur., Ac. nit, Ac sulph., Am., Ars., 
Baryta, Bell., Calend., Canth., Carbo v., Caust., Cham., Chin., 
Con., Cuprum, Dros., Euphorb., Graph., Hep., Hyos., Iod., Lye, 
Kali c, Merc, Nux v., Petrol., Rhus rad., Rhus tox., Sepia, 
Sil., Sulph. 

Inflamed Ulcers : Acid mur.., Ac. nit., Amm. c, Apis, Arg. nit., 
Am., Ars., Aur., Bell., Bovista, Calend., Canth., Carbo v., 
Caust., Clem., Hep. s., Hyos., Kali c, Kreos., Lye, Merc, s., 
Natr. c, Natr. m., Phos., Ruta, Sep., Sil., Staph., Thuja. 

Sloughing Ulcers: Acid nit., Ac. sulph., Arg. nit., Ars., Aur., 
Bry., Calc c, Calend., Canth., Carbo v., Caust., Cham., Chelid., 
Chin., Con., Euphorb., Hep. Lach., Merc s., Ranunc, Rhus 
tox., Secale, Sil., Tart. em. 

Varicose Ulcers: Hama. virg., Amm. mur., Arn., Ars., 
Calend., Carbo v., Chin., Merc, Sulph., Tart, em., Verat. 

Hemorrhagic Ulcer: Acid phos., Amm. c, Ars., Bovista, Calc 
c, Calend., Carbo v., Caust., Cham., Graph., Kali c, Kreos,, 
Lye, Merc, Natr. m., Nux v., Puis., Sulph., Sep. ? 

Pus: Black. — Sulph., Chin. 

— — Bloody. — Ars., Hep., Merc, Carbo v., Caust., Lye, Nit. 
ae, Puis., Sil. 

Pus: Brownish. — Bry., Sil., Ars., Carbo v. 

— Grayish. — Caust, Sil. 

— — Greenish. — Caust, Puis., SiL, Aur., Clem., Merc, Nux v., 
Rhus, Sep. 
' Whitish. — Calc. c, Lye, Amm. e, Ars., Sep., Sil., Sulph. 

— Yellow. — Puis., Calc. c, Carbo v., Caust, Clem., Merc., 



Phos., Sep., Sil., Staph. 



Special Therapeutics. 357 

Pus: Copious.— Puis., Sep., Ars., Calc, Merc, Phos., Rhus, Sil. 

Scanty. — Calc. c, Lack., Merc, SiL, Bell, Cupr., Dulc, 

Hep., Sep., Verat. 

— Corroding. — Ars., Caust., Merc, Rhus, Sil, Carbo v., Hep., 

Lye, Nit. ac, Ranunc bul 

Ichorous. — Ars., Carbo v., Merc, Nit. ac, Rhus, Sil, 

Caust., Chin., Staph. 

Cheesey. — Merc. 

Gelatinous. — SiL, Arg., Merc, Sep. 

Thin. — Caust., Merc, Sil, Sulph. 

Viscid. — Merc, Bovista, Con. 

Watery. — Caust., Merc, Ars., Ranunc, Rhus, Sil. 

Putrid. — Hep., Phos. ac, Sulph., Ars., Calc, Chin., Graph., 



Lye, Merc, Sep., Sil 

— Sour smell. — Hep., Merc, Sulph. 

— Smelling like herring brine. — Graph. 

— Smelling like old cheese. — Hep., Sulph. 

— Like tallow. — Merc. 



Ulcers from Abuse of Mercurius: Aur., Bell, Carbo v., Hep. 
s., Lach., Lye, Nil. ac, Phos. ac, Sep., Sil, Sulph., Thuja. 

Acid mur. Stinging, itching, and painful ulcers ; foetid odor in 
the ulcer, although it is covered with a scurf; when touched there 
is a stinging pain ; putrid ulcers, with a burning pain or heat in 
the edges ; jerking pains. Pus, foetid and scanty. 

Worse in the afternoon, and during the forepart of the night ; 
also from cold, on lying down, on trying to lift any heavy weight, 
and in windy weather. 

Better from pressure, and on scratching. Left side chiefly. 

Acid nit. Drawing pain in the ulcers, which are very sensitive, 
and have an offensive odor ; burning pain and heat in the edges ; 
shooting and pricking pains ; superficial ulcers ; ulcers produced 
by Mercury. Pus, foetid. 

Worse in the morning, evening, and at night ; also from bathing 
in cold water, on awakening from sleep, when lying on the affected 
side, and from being touched. 

Better in dry weather. Left side. (Since writing the notes 
from which this is copied, the following additional symptoms have 
been found, and proven reliable in one or two cases : Readily- 
bleeding deep ulcers; fistulous ulcers difficult to heal; pricking 
in the ulcers. Pus, copious, bloody, corroding, or ichorous.) 



358 Ulcer, 

Acid phos. Inveterate ulcers ; itching ; indented base ; burn- 
ing pain ; ulcers without much feeling ; painless ulcers ; putrid, 
sensitive ulcers, with some pain. Pus, foetid and dirty-colored. 
Worse after midnight, and in the morning; also when lying on 
the painful side, before menstruation, from being touched, and on 
getting warm in bed. 

Better on changing the position, and moving about. Either side. 

Acid Slllph ? Gangrenous ulcer ; corrosive sensation in the 
ulcer; biting and cutting in the ulcer. Pus is corrosive. 

Worse in the forenoon, and in the evening ; also on getting up 
after lying down. Right side generally. 

Ambra grisea ? Burning or itching in the ulcer ; painless ; 
chronic ulcers worse every spring; stinging in the ulcer. Pus f 
grayish, or salty ichor. 

Worse in the evening ; also on lying down, or when awaking, 
and getting up after sleep. 

Better on getting up and moving about after sitting some time. 
Either side. 

Ammonia Carb. Putrid ulcers; flat ulcers, with a pungent 
sensation. Pus, white and putrid. 

Worse in the evening; also on awakening from sleep, from cold, 
when lying on the painful side, after lying down, before the cata- 
menia, and from wet poultices. 

Better from keeping the limb elevated, and outward pressure. 
Either side. 

Ammonia mur ? Ulcers with, for the first few days, an itching 
in and around them, followed by a burning. 

Worse in the morning and evening. Either side. 

Antimonium Crud. Fistulous, deep or flat ulcers ; pain as if 
they were burnt ; spongy ulcers with an itching or pricking ; ulcers 
with high exuberant granulations ; spongy ulcers with a sore pain 
in them. Pus, scanty. 

Worse in the evening ; also from bathing them, on getting heated 
near the fire, and on turning the part. 

Better in the open air. Left side. 

Argentum met. Boring pain in the ulcer. Pus, copious, gela- 
tinous, bloody or yellow, and sometimes corrosive. 

Worse in the forenoon, and in the afternoon ; also when lying 
down in bed, and on descending an eminence. 



Special Therapeutics. 359 

Better in the open air, on ascending an eminence, and on rising 
from the seat and moving about. Left side chiefly. 

Arnica mon. Jerking pain in the ulcer ; bluish ulcers ; readily- 
bleeding ulcers ; indurated ulcers ; induration of the surrounding 
skin ; inflamed and itching ulcers ; painless ; pricking, pulsative, 
and sensitive ulcers ; swollen ulcers with shocks, and feeling ot 
tenseness. Pus, bloody or gelatinous. 

Worse in the evening, and at night ; also from any bodily exer- 
tion, walking and moving, or turning the affected part. 

Better from warmth, when letting the limb hang down, from 
pressure, and when lying down. Left side. 

Arsenicum alb. Burning in the interior of the ulcer; pains are 
felt while sleeping; burning as if the ulcer were on fire; mortify- 
ing, putrid ulcers, with high edges, and shining redness of the sur- 
rounding skin; the base of the ulcer is either of a black-blue color, 
or has the appearance of lard ; foetid ichor, and proud flesh in the 
ulcer; thin scurf on the surface, it bleeds slightly on bandaging 
it ; flat, gangrenous, or inflamed ulcers ; the surrounding skin is 
of a dusky-red, or rather of a purple color. Pus, copious, bloody, 
ichorous or corrosive, putrid, thin and watery. 

Worse at night ; also before falling asleep, and again on awaking, 
from the cold, and in cold weather, any exertion of the body, lying 
on the painful side, on ascending an eminence, after moving about, 
from drinking liquors, and in windy weather. 

Better from warmth, on getting warm in bed, lying on the sound 
side, descending, and on rising from the bed. Either side. 

Asafcetida. Ulcers with intermittent, pinching pain. 

Aurum met. Mercurial ulcers; itching, shooting, or burning 
pains ; bluish-red, deep, fistulous, swollen and painful ulcers. 
Pus is yellow and foetid. 

Worse in the morning; also during rest. 

Better from motion, and while lying down in bed. Right side. 
(Low-spirited, sad, and constant thoughts of suicide.) 

Baryta Carb. Gnawing pain ; burning, or a pain as if burnt 
in the ulcer ; corroding pains ; scabby, crusty ulcers ; indurated 
ulcers, difficult to heal; inflamed, itching ulcers; painless ulcers; 
pricking and pulsating; swollen ulcers, with a feeling of tenseness. 
Pus scanty, or totally wanting ; gelatinous and scanty. 

Worse in the night ; also from cold, lying on the sore side, lifting 
the part affected, and from pressure. 



360 Ulcers. 

Better when lying on the sound side. Left side. 

Belladonna. Desire to remain still; dread of motion; burning 
in the ulcers on touching them ; soreness and inflammation around 
the edges, with a black crust of blood in the center ; deep, scabby 
ulcers with cutting pains ; fistulous indurated ulcers, with indura- 
tion of the surrounding skin ; painless, though inflamed ulcer, or 
those with pricking, redness, and inflammation of the skin, for 
some distance around them; inflamed, sensitive, and swollen 
ulcers. Pus scanty, bloody and ichorous. 

Worse at night ; also on motion, however little, and from the 
lightest touch. 

Better while standing. Right side. 

Bovista ? Itching and burning in the ulcers ; scabby ulcers ; 
inflamed, itching ulcers ; painless ulcers ; pricking or pulsating in 
the ulcers. Pus scanty, ichorous, putrid, viscid, or yellow. 

Worse in the morning and evening. Left side chiefly. 

Bryonia alba. Ulcers with a smarting pain; stinging when 
moving ; throbbing in the ulcers ; induration of the edges. Pus 
brownish. 

Worse at night, after midnight, and in the morning; also before 
falling asleep, from exertion of the body, on getting heated, when 
lying on the sound side, on going up an eminence, from motion, 
or motion of the part, from making pressure on the side of the 
limb opposite to the ulcer, on rising from the seat or the bed, 
in summer and winter, when the weather changes, and during 
walking. 

Better when descending an eminence, lying on the sore side, 
from scratching, and while sitting still. Right side. 

Calcarea Carb. Unwholesome, readily- ulcerated skin; scrofu- 
lous ulcers ; fistulous ulcers, with redness, hardness, and swelling 
of the surrounding skin ; carious ulcers ; cutting pain ; inflamed or 
putrid ulcers ; high and feeble granulations, without much pain ; 
painful soreness ; tearing and throbbing in the ulcers ; the ulcers 
are white or yellow. Pus scanty and albuminous. 

Worse in the mornings ; also just before falling asleep, on 
awaking, when letting the limb hang down, before menstruation, 
from wet poultices, in the spring of the year, when turning the 
part, and in wet weather. 

Better when keeping the limb elevated, in dry weather, and from 
rubbing or scratching. Right side. 



Special Therapeutics 361 

Calcarea phos? Carious ulcers; sensitive, easily excited, ill- 
humor, and want of disposition to do anything. The warmth of 
the room is intolerable. 

Calendula Off. Excessive secretion of pus; inflamed ulcers; 
painful as if beaten ; surrounding parts are red ; stinging in the 
ulcer during fever. 

Worse at night, with some fever. 

Cantharides. Ulcers with itching and lacerating; burning in 
the ulcers; smarting and stinging in the ulcer. Pus copious, 
inodorous, slightly yellow, and sometimes tinged with blood. 

Worse in the afternoon, and at night ; also from drinking coffee, 
from rubbing, and from scratching. 

Belter when lying down. Right side. 

CarbO veg. Pressure and tension around the ulcer in the leg; 
an ulcer which has become cured breaks out again, and instead 
of pus, emits a bloody lymph ; the surrounding parts are hard to 
the touch ; burning in the ulcer. Pus brownish, foetid, or foetid 
sanies ; cadaverous-smelling and corroding scanty secretion. 

Worse in the morning, and at night before midnight ; also in 
the open air, evening air, before menstruation, and from warmth. 
Either side. 

Causticum. Bleeding ulcers, with blisters on the surrounding 
skin; boring and burning in the ulcers ; burning in the edges ; pain 
as if burnt ; sensitive ulcers, with pustules around them ; swollen, 
with a feeling of tenseness in them. Pus is bloody and corroding, 
greenish or gray, ichorous and thin as water, sometimes yellow. 

Worse in the afternoon, and sometimes during the forepart of 
the night; also from cold, on just waking up, from drinking coffee, 
from rubbing or scratching, in clear, dry weather, and in a north 
wind. 

Better in damp weather, and on wetting the ulcer. Right side. 

Chamomilla VUlg. The skin is unhealthy, and every cut or 
abrasion ulcerates; an existing ulcer hitherto painless, suddenly 
becomes painful ; darting or lacerating, smarting or burning pain 
at night ; creeping in the ulcer, with excessive sensitiveness to the 
touch ; great sensitiveness to the currents of air, and to the wind. 

Worse at night; also in the open air, during menstruation, from 
motion of the affected part, wet poultices, pressure on the side of 
the limb opposite to the ulcer, on rising from the seat or bed, from 
drinking coffee, from the heat of the bed, and in windy weather. 



362 Ulcers. 

Better from cold. Left side principally. 

Chelidonilim. Old, putrid, spreading ulcers ; when lying in bed 
at night there is a chill with a warm body ; deep, fistulous, spread- 
ing, itching ulcers. 

Worse in the morning; also in the open air, on turning the part, 
and when walking. 

Better from a firm pressure. Either side. ■ 

China Off. Boring, with painful sensitiveness in the ulcer; 
beating pain, only when moving the part ; burning and pressing, 
or digging; foetid, flat and gangrenous ulcers. Pus bloody, ichor- 
ous and foetid. 

Worse at night; also in the open air, from motion, from the 
lightest touch, and in windy weather. Left side chiefly. 

Clematis erecta. Burning, creeping, jerking, throbbing or 
shooting in the ulcer; shooting pain in the ulcer, only when 
touched ; scabby, deep ulcers ; indurated ulcers, with high elevated 
edges, difficult to heal ; itching in, and around about the ulcer. 
Pus serous, yellow, acrid or ichorous ; scanty secretion, or total sup- 
pression of pus. 

Worse at night; also from poulticing. 

Better when washing the sore. Left side. 

Conilim mac. Pains at night which rouse the patient from 
sleep; bleeding ulcers ; the edges become black ; gangrene of part 
of the ulcer ; creeping, with a tensive pain ; ulcers which are blue- 
ish, have a livid appearance and are tumid ; pain in the part as if 
it were being beaten to pieces ; burning, crusty and deep ulcers ; 
painless, hard and fistulous; swollen ulcers, hard to heal; inflamed 
ulcers, with a feeling of tenseness. Pus fetid, watery and ichorous. 

Worse at night ; also on descending an eminence, on beginning 
to move, before menstruation, pain from rubbing or scratching, or 
when either sitting or standing a long time. 

Better on ascending an eminence, on letting the limb hang down, 
from motion, and from pressure. Right side. 

Cuprum met? Old ulcers, with a feeling of contraction in the 
surrounding skin ; fat ulcers ; hard and inflamed ulcers, with a 
jerking pain ; sensitive ulcers, with redness of the areolar. Pus 
scanty and corroding. Left side. 

Dulcamara. Insensible, painless ulcers; hard, sensitive and 
swollen ulcers ? Pus scanty and yellowish. 

Worse in the night; also from cold or wet, and when the 
weather changes. 



Special Therapeutics. 363 

Better from motion, and movement of the part. Left side chiefly. 

Drosera rotund ? Bleeding, burning ulcers; cutting pain ; Pus 
bloody, thin and watery, and ichorous. 

Worse in the morning and during the latter part of the night ; 
also when lying on the sore side, when sitting, and when getting 
warm in bed. 

Better from cold, from rubbing, and while walking. Right side. 

Eliphorbilim Off. Old, torpid ulcers ; lancinating and lacerat- 
ing pains ; ulcers turning black; insensible ulcers; biting in the 
ulcer; gangrenous ulcers. 

Worse in the morning; also on getting heated near the fire, lying 
down, when changing the position, on beginning, to move, while 
sitting, and when touching them. 

Better from motion and walking. Left side; though may be 
either side. 

Graphites. Unhealthy ulcers ; proud flesh in the ulcer; tear- 
ing ; crusty or scabby ulcers ; hard itching ulcer, difficult to heal ; 
sensitive sore spongy ulcers, that emit a salty flux. Pus bloody, 
watery acrid and corroding; putrid pus, or smelling like herring- 
brine. 

Worse at night, before midnight ; also during and after menstru- 
ation, and on moving. 

Better when lying down, and from pressure. Right side. 

Hepar SUlph. Mercurial ulcers ; burning in the ulcers ; burn- 
ing in the night only ; pains resembling recent excoriation ; throb- 
bing and shooting; ulcers with jagged edges, and surrounded by 
pustules ; bluish bleeding ulcers, with a burning pain in them, 
and surrounded by blisters. Pus may be laudable, acrid, or san- 
guineous; smells like old cheese; or it may be fetid and ichorous. 

Worse at night, and in the morning; also on first waking up, 
from cold, when lying on the sore side, from pressure, on touching 
them ; in clear dry weather, and in a north or east * wind. 

Better when lying on the sound side, and in damp weather. 
Left side chiefly. 

HyoSCyamus nig. Inflamed ulcers, the surrounding skin being 
of a bright vermillion redness ; large pustules around the ulcers. 

Worse in the evening; also during menstruation, and on touch- 
ing it. 

Better when getting warm. Left side. 

* In Germany, from whence we get this proving, an east wind is a dry one. 



364 Ulcers. 

Jodium. Bleeding ulcers; destitute of feeling; hard, spongy 
and sensitive ulcers ; swollen ulcers, with a feeling of tenseness or 
soreness; Pus copious, bloody and corroding; or thin, watery and 
yellow. 

Worse at night ; also when lying down on the sore side, from 
pressure, on getting warm in the open air, from bodily exertion, 
and from rapid walking. 

Better from cold, and when lying on the sound side. Either 
side may be affected. 

Kali bich. Ulcers dry, form oval; have overhanging edges, a 
bright red inflamed areolar, hard base ; movable on the sub-jacent 
tissues, dark spot in the center ; after healing, the cicatrix remains 
depressed ; the ulcers corrode and become deeper, but without 
spreading in the circumference ; ulcers on the previously inflamed 
feet ; ulcers on the fingers, with carious affections of the bones. 

Worse in the morning ; also from cold, and during the summer. 

Better from heat. Either side. (Lippe.) 

Kali carb. Gnawing in the ulcer ; bleeding, burning, boring, 
corroding ulcers. Pus copious, bloody, and ichorous; or thin and 
watery. 

Worse at night, after midnight, and in the morning ; also from 
cold, on getting heated, during menstruation and after moving. 

Better from getting warm. Either side. 

KreoSOte. Burning, or pain as if burnt in the ulcer; putrid 
ulcers ; sensitive ulcers ; spongy ulcers. Pus acrid or ichorous, 
fetid or yellow. 

Worse in the morning; also after menstruation. Left side 
chiefly. 

Lachesis. The ulcer is large, and has a tendency to extend 
rapidly ; surrounded by smaller ulcerations or pustules ; consider- 
able swelling, with a mottled, dark-blue or purple color of the 
surrounding skin ; burning pain only when touching the sore ; 
ulcers which are smooth, but have jagged edges, are surrounded 
by papillae, and are bluish or livid in appearance. Pus scanty. 

Worse in the evening, and at night before midnight; also in 
windy weather, in the open air, on changing the position, from 
pressure, while sitting, and in wet weather. 

Better when lying down, on rising from the seat, and in wet 
weather. Right side usually. 

Lycopodium. Fistulous ulcers, with hard, red, shining and 



Special Therapeutics. 365 

inverted edges; inflammatory swelling of the affected part; 
itching in them only or chiefly at night ; also when touching them ; 
gnawing, shooting or tearing pain ; tumid ulcers, with elevated and 
indurated edges ; surrounded by papillae. Pus copious and albu- 
minous ; or sanious, gray, yellow, or acrid. 

Worse in the afternoon and in the evening; also while lying 
down on the sore side, before menstruation, on beginning to move, 
from pressure, while sitting, on being touched, and on beginning 
to walk. 

Better from cold, on motion, and on getting warm in bed. Right 
side chiefly. 

MerCUrillS SOl. Spreading ulcers; spongy, readily-bleeding 
ulcers ; ulcers are exceedingly painful, and sensitive to the slight- 
est touch; unequal elevations and depressions; (neither hot nor 
cold applications allay the intolerable darting, lancinating pain,G.) ; 
gnawing or throbbing pain ; ulcers of a bluish or livid appearance, 
with hard, elevated and jagged edges; superficial ulcers, of a 
whitish appearance. Pus may be scanty or copious, and of almost 
any appearance, (save laudable, G.) 

Worse in the evening, and at night ; also in the evening air, from 
or during walking or motion, from the slightest touch, on getting 
warm in bed, and in wet weather. 

Better from cold (?), while lying down, and while sitting. Left 
side mostly. 

Mezereum. Pain of a burning character, or feeling as if from 
a recent excoriation ; .shooting pains ; biting pains ; pricking in the 
ulcer, or soreness ; feeling of tenseness in the ulcer. Pus scanty 
or totally suppressed. 

Worse in the evening, and in the night before midnight ; also 
from rubbing, from scratching, and from being touched. 

Better in the open air. Left side. 

Natmm Carb. Burning ulcers ; pricking and pulsating in the 
ulcers. Pus corroding, acrid, putrid and yellow. 

Worse in the forenoon ; also when lying down. 

Better from pressure, on getting up after sitting, and from rub- 
ring or scratching. Left side principally. 

Natrum mur. Superficial ulcers ; red, angry-looking, smarting 
ulcers, surrounded by vesicles. No suppuration. 

Worse in the morning, and in the forenoon ; also from bodily 
exertion, before and after menstruation, from motion, and on mak- 
ing pressure. 



366 Ulcers. 

Better while and after lying down. Right side. 

NlIX vomica. Raised ulcers with pale red edges; pain as if 
being beaten to pieces; burning pain as if burnt; jerking pain; 
prurient itching; sensitive, sore ulcers, with a feeling of tenseness; 
Pus greenish and corroding. 

Worse in the morning, and at night ; also in the open air, after 
menstruation, while lying on the back, on moving the part, when 
touching the ulcer, when drinking liquor or coffee, when walking, 
in clear dry windy weather, and in winter. 

Better when lying on the sound side, when sitting, and in damp 
weather. The right side chiefly. 

Petroleum. Fistulous ulcers; rapidly spreading; shooting pain, 
with elevated, indurated edges ; deep or flat ulcers that are difficult 
to heal ; pricking in the ulcer's edges, or areolar ; proud flesh in 
them ; redness of the areolar ; painful, sensitive and spongy ulcers. 
Pus scanty, acrid and corroding ; sanious and watery. 

Worse in the morning ; also in the open air, from cold in general, 
and in winter. Right side. 

Phosphorus. Fistulous ulcers, with callous edges ; gnawing 
pain ; hectic fever. Pus fetid and badly colored ; scanty, and 
again is easily secreted. 

Worse in the evening and at night before midnight ; also before 
falling asleep, on awakening, when the weather changes, and in 
the wind. 

Better on awakening. Right side generally. 

Pulsatilla. Flat, putrid carious ulcers ; fistulous ulcers ; itch- 
ing, burning or excoriated feeling in the ulcers ; smarting and 
shooting pains ; the surrounding parts are discolored ; indurated 
and elevated edges ; ulcers surrounded by papillae. Pus copious, 
albuminous and yellow ; also bloody, or green. 

Worse in the evening, in the afternoon, and at night before mid- 
night ; also on changing the position, while lying on the sound side, 
after lying down, during menstruation, on beginning to move ; also 
after moving, on pressure on the side of the limb opposite to the 
ulcer, on rubbing or scratching, while sitting, and in windy or win- 
try weather. 

Better in the open air, from cold in general, motion, on walking, 
and on wetting the affected part. Right side. 

Ranunculus bulb. Itching or burning in the ulcer; shooting 
pains ; smooth ulcers ; boring in the ulcers ; flat, superficial ulcers, 
with pricking in them. Pus sanious and acrid. 



Special Therapeutics. 367 

Worse in the morning, afternoon, and evening, and at night 
before midnight ; also from cold in general, and on being touched. 

Better while standing. Either side. 

Rhus rad. Hard red edges, and itching of the ulcers ; sore, 
inflamed ulcers ; itching-smarting, or itching-biting in the ulcer ; 
feeling as if salt were in the ulcer ; erysipelatous inflammation 
and swelling of the surrounding skin ; the skin in the neighbor- 
hood was covered with itching, burning vesicles, smarting on 
scratching them. 

Worse in the evening, and at night ; also from cold, on begin- 
ning to move, from drinking cold water, and when the weather 
changes. 

Better from motion. Either side. 

RhllS tOX. Small vesicles, turning to putrid, gangrenous and 
spreading ulcers ; violent fever ; tingling and smarting as if from 
salt in the ulcers ; burning, creeping or crawling sensation, with a 
pain resembling a recent excoriation ; smarting and soreness ; 
ulcers surrounded by papillae. Pus sanious and acrid. 

Worse in the morning, evening, and at night after midnight; also 
before falling asleep, in the autumn and spring, from bathing in 
cold water; also from exertion of the body, when lying down, from 
poultices, when the weather changes and in wet weather. 

Better from motion, and motion of the affected part, while walk- 
ing, and in dry weather. Either side may be affected ; chiefly, 
however, the left. 

Ruta grav. ? Gnawing, jerking pains. Pus sanious. 

Worse in the afternoon ; also in damp weather, and while he is 
sitting or lying still. 

Better on motion. Left side chiefly. 

Sabina. ? Deep ulcers; pricking, feeling of tenseness in the 
ulcer. 

Worse in the morning, and in the evening ; also from exertion of 
the body, from being touched, and on getting warm in bed. 

Better in the open air, from cold, and on raising or elevating the 
limb. Left side. 

Secale COr, Bleeding ulcers ; ulcers becoming black ; feeling 
as if burnt ; painless ulcers ; pricking, producing a prurient secre- 
tion. Pus putrid. 

Worse at night ; also from being touched, and on getting warm 
in bed. 



368 Ulcers. 

Better from cold. Right side. 

Sepia. Ulcers with blisters around them ; pain as if burnt ; 
deep, crusty (scabby) ulcers ; flat ulcers with digging pain ; desti- 
tute of feeling ; fistulous, hard ulcers ; high elevated edges ; hard 
to heal; jerking, itching or pricking; proud flesh in them; pustules 
around the ulcer, with redness of the areolar; sensitive, sore, 
spongy or swollen ulcers ; swelling of the edges, with tearing in 
the ulcer. Pus is copious, corroding, gelatinous, greenish or 
ichorous ; or it may be scanty, putrid, viscid, sour-smelling, and 
whitish or yellow ; thin salty ichor. 

Worse in the morning, forenoon and evening ; also before falling 
asleep, and on awaking, while sitting, and from being touched. 

Better on awaking, and when rising from the seat. Right side. 

Silicea. Aching pain in the ulcer; it becomes black at the base, 
or on the edges ; bleeding from the base or edges ; boring or burn- 
ing in the edges, or in the areolar ; sensation of coldness in the 
ulcer; deep or flat, crusty ulcers; destitute of feeling; hard, fistul- 
ous or gangrenous ulcers ; ulcers with high, hard edges ; difficult 
to heal ; jerking and itching in or round about the ulcers; pricking 
in the edges and areolar; proud flesh in the ulcer; pulsating, 
putrid ulcers, with redness of the areolar; sensitive edges; spongy 
ulcers, or only spongy on the edges; swollen ulcers with white 
spots and tearing pain. Pus copious, brownish, corroding, gelatin- 
ous; or grayish, bloody, or ichorous; scanty, putrid, thin, and 
watery and yellow. 

Worse in the forenoon, afternoon, in the evening, and at night ; 
also in the open air, when lying on the painful side, from pressure, 
and when the weather changes. 

Better when lying on the sound side. Either side. 

Staphisagria. Itching or burning in the ulcer; gnawing, jerk- 
ing, shooting or tearing pains ; smarting in the ulcer. Pus excessive, 
acrid, ichorous and fetid ; or scanty. 

Worse in the morning, forenoon, in the afternoon, and at night ; 
also on moving, from pressure, and on being touched. 

Better in the evening and when lying down in bed. Principally 
the right side. 

Sulphur. Readily - bleeding ulcers; ulcers with raised and 
swollen edges ; surrounded by pimples ; fistulous ulcers ; stinging 
and lacerating in the ulcers ; proud flesh in them ; violent bleed- 
ing of old ulcers; irregular jagged edges; cedematous swelling, 



Special Therapeutics. 369 

and reddish-brown discoloration of the skin. Pus thick, yellow, 
and foetid ; or thin and foetid. 

Worse in the evening, and at night; also on awaking, from 
bodily exertion, while lying down in bed, before menstruation, 
from poultices, from being touched, and on getting warm in bed. 

Better from cold, on rubbing or scratching, and in dry weather. 
Left side. 

Thuja. Ulcers with indurated edges ; elevated jagged edges ; 
surrounded by blisters containing pus ; deep, burning and fistulous 
ulcers; itching, pricking, and proud flesh in the ulcers; pulsating, 
spongy ulcers, or only spongy on the edges ; feeling of tenseness 
in the ulcers ; ulcers with serrated edges. Pus yellow. 

Worse in the afternoon ; also on rising from the bed. 

Better from rubbing or scratching. Either side. 

Tartar emetic. Deeply-penetrating, malignant ulcers; broad 
and deep sloughing ulcers; gangrenous ulcers, with hectic fever; 
ulcers are surrounded by black pustules, which break down into 
deep ulcers. Pus, absent ; merely an oozing of foetid humor. 

Worse in the morning. Either side. 

Veratrum album. Bluish ulcers ; hard, indurated ulcers ; itch- 
ing, painless ulcers, but with redness of the areolar. Pus scanty. 

Worse in the morning; also in the autumn or winter, when 
standing, and on getting warm in bed. 

Better on rising from the bed, and in dry weather. Either side 
may be affected, though the right side is usually so. 

Zincum met. Herpetic ulcers ; bleeding and burning ulcers ; 
destitute of feeling ; itching ; redness of the surrounding skin ; 
sore ulcers ; tearing, and feeling of tenseness of the ulcer, and the 
surrounding parts. Pus bloody and corroding. 

Worse in the afternoon and evening; also on getting heated near 
the fire. 

Better from rubbing or scratching. Left side. 

In the last few years, a number of " new remedies " have been 
introduced to the profession, that are as yet, however, hardly 
established enough to warrant their insertion here. The mass of 
them have not been tested by myself in these cases, and those only 
that I have used will be noticed ; and among them, only such as 
have proved curative. 

Apis mel. This remedy has been used in perhaps five cases, 
and cured promptly the following symptoms and conditions; small 
24 



370 Ulcers. 

ulcers ; large, spreading ulcers, that are surrounded by pimples ; 
redness and heat in the areolar; pricking in the ulcer; stinging in 
the ulcer and in the areolar ; high florid granulations. Pus thick, 
white, acrid, and corroding. 

Worse in the morning ; also from heat. 

Better from cold water applications, and from pressure. Left 
side. 

Hydrastis Can. This remedy has been used but once by me, 
and acted very satisfactorily, though the result could not be called 
a cure properly. It seems to be closely analogous to Mercury. I 
plead guilty, however, to having departed from my usual practice 
and teaching in this case, by using it as a topical application. 
The reason for this was, that there was no opportunity at the time 
of getting a tincture or dilution, and a preparation of the dried 
root steeped in water was only available. The symptoms were as 
follows: they were all cured except the pain — ulcer closed and 
all — and this was removed by one dose of Cham. 6. Ulcers on 
the legs ; dry, superficial, and angry-looking ; covered by a yellow 
scab; pain was stinging, or stinging-burning; areolar inflamed, 
and covered by pimples, which frequently degenerate into ulcers ; 
faint-fetid odor ; circular shape, with flat edges ; one of the ulcers 
had high and thick edges. No pus. 

Worse at night ; also from the warmth of the bed, on motion, 
or on touching them. Left side. 

Hamamelis Virg, This is one of the best remedies in our whole 
Materia Medica for the treatment of varicose ulcers. I am almost 
tempted, in spite of homoeopathy, to call it a specific. It has 
cured in my hands probably ten ulcers of that description. The 
symptoms are: deep, circular, flat ulcers; ulcers that are very 
dark, almost black at the base ; the surrounding skin is bluish- 
black; oozing of blood; burning and stinging, or biting in the 
ulcer; the edges are on a level with the surrounding skin, and are 
sharp cut. Pus very thin and Watery, bad smelling; more an 
ichor than pus. 

Operations. 

The operations that are occasionally required for the cure of 
obstinate ulcers, are two in number, viz. : plastic operations, and 
amputation. The former of these is one of the most beautiful pro- 
cedures in our art, and is one that requires a good eye, and consid- 



Special Therapeutics. 371 

erable skill in its performance. Still, like many other "beautiful " 
things, it lacks in usefulness. It often fails. Nor can we wonder 
at this. On turning to the opening pages of this chapter, we see 
that the existence of an ulcer depends upon a diseased state of the 
the whole system, that renders the formation of new healthy 
material, and firm cicatrization equally impossible. How can we 
then expect a transplanted portion of the integument diseased 
itself, to adhere to these old diseased surfaces, that have not vital- 
ity enough to resist the continued encroachments of the malady? 
When an ulcer has been healed, but leaves an ugly scar, or from 
the contraction due to this process gives rise to considerable 
inconvenience and deformity, then an operation of this nature 
is admirable. But under other circumstances, when the ulcer 
remains open, and the diseased action is consequently not sus- 
pended, all such methods are worse than useless, inasmuch as 
they give no relief, and only subject the patient to additional suffer- 
ing that is entirely uncalled for. 

In some severe cases of sloughing or phagedenic ulcer, it may 
possibly be found necessary, on purpose to save life, to amputate. 
This is the last resort and should not be thought of. No ulcer is 
actually incurable. We may not cure it, but it only proves our 
imperfect knowledge of our remedies, and not their powerlessness. 
In such cases, amputation is truly " the reproach of surgery," and 
is a measure I cannot conceive of ever being the only one left. 
If remedies do fail, even use styptics, acids, anything but this 
cruel operation. 

The method of performing either of these operations is fully 
developed in works of a different character. 



tf2 Gangrenous Diseases. 



GANGRENOUS DISEASES. 

MORTIFICATION, BED-SORES, SLOUGHING PHAGE- 
DCENA, CARBUNCLES, BOILS. 

Mortification. 

Mortification, or gangrene, is the death of a part, and is usu- 
ally applied to death of soft parts. Dunglison says, that in the 
incipient stages, or when recovery is possible, gangrene is the 
proper term ; when the part, however, is totally destroyed, he 
calls it sphacelus. Erichsen gives a different meaning to the 
terms. Death of any part, according to his teaching, is gangrene, 
whether bone, or soft parts. But when the soft parts are alone 
involved, it is sphacelus. This nomenclature is the one I have 
adopted, and is that usually applied by the profession at large. 

Gangrene is spoken of as " acute " or " chronic," " traumatic " 
or "idiopathic," "hot" or "cold," "dry" or "humid." Old- 
school authors divide these into two grand divisions, " constitu- 
tional" and " local." The last condition is a merely suppositious 
and impossible one, unless they mean gangrene confined to one 
part — as a finger, or the nose ; even then the fault lies deeper 
than that one point. It must be a constitutional disease. *When 
occurring in elderly people, from deficient or impaired nutrition, 
we speak of it as " senile." 

The causes of gangrene are numerous. It may result from a 
mechanical injury, as an interruption of the circulation from a 
severance of a large arterial trunk, from deficient circulation in 
elderly people, or from impeded circulation — ist, structural dis- 
eases of the arteries, as calcification, or ossification ; 2nd, sudden 
arrest of the flow of blood by ligature after operations ; 3rd, return 
of the blood by the veins being obstructed by strangulation, as 
when a bandage is applied so tightly that constriction of these 
vessels follows ; 4th, by the long-continued pressure of some foreign 
body on the main arterial trunk — as from tumors, bullets, or 



Mortification. 373 

hard compresses ; finally, intense inflammation, by engorging 
the vessels, and impeding the flow of. blood, or the application ot 
specific poisons. Other causes there may be, but they all, to a 
greater or less extent, exert their influence by an interruption 
or obstruction of the circulation, both arterial and venous. 

In regard to the curability of gangrene, much might be said, 
but the whole question depends upon the cause, the age, the habits 
of the patient, and the nature of each particular case. There 
seems to be some considerable division of opinion on this subject, 
one party saying because it is gangrene, it can never be cured, and 
the others that it is always amenable to treatment. Both parties 
are partly right ; for if the case is at all favorable, it can cer- 
tainly be cured ; but the assertion that it is always curable, is 
too broad, and consequently not true. 

The conditions under which a cure by medicinal agents may 
be hoped for, are as follows : The surface, or part implicated, 
is small in extent, the disease is rapid in its progress, accom- 
panied by more or less pain, moist inflammation of the surround- 
ing parts moderate, occurring in young people, and ordinarily 
when resulting from mechanical injury. A cure is almost hope- 
less when its invasion is slow, but steady, part dry, when the 
disease results from intense inflammation, no pain, or very little, 
when occurring in old people, from the calcification or ossifica- 
tion of arteries, and from injuries to persons of a debilitated 
constitution. Although these conditions are unfavorable, yet 
they are only that, and so nothing should be left untried, ere 
resorting to amputation. 

"When should we operate?" is a question often propounded. 
When remedies prove themselves to be utterly powerless. Some 
few suggestions about the indications for an operation may be 
given here. Mortification, when it has reached its limit, forms 
an ulcerated line, separating it from the living tissues. This is 
called the "line of demarkation." It is a rule among surgeons 
to wait until this line has formed before amputating, as (they 
say) gangrene will very likely invade the stump. Under homoeo- 
pathic treatment it has been proven to me three times, that in 
traumatic cases, at least, no such precaution is necessary. Idio- 
pathic cases had best be allowed to wait for this line. As soon 
as remedies, when well-selected, give unmistakable evidence that 
they are powerless to arrest the disease, amputate at once, and 



374 Gangrenous Diseases. 

in the majority of cases no trouble will be experienced in the 
subsequent treatment. Why, if the line of demarkation has not 
formed, how can we tell but what it may form only after the 
whole limb has been diseased ? and if we amputate, and gangrene 
then invades the stump, is the patient in any worse condition 
than if we had waited until it had got past that point ? We have 
given him a chance, and us more time to test the remedies ; and 
as the limb would have to come off anyhow, there is no " unne- 
cessary maiming done." One case may be cited here to prove 
the truth of this assertion: On the 22nd of September, 1865, was 
called to see a boy who had his left foot badly crushed between 
the bumpers of two coal cars. Under allopathic treatment, and 
under the care of one who dare not amputate before the gan- 
grene set in, his foot from the toes half-way up to the ankle 
was mortified — foot black, moist, and painless. The surround- 
ing skin was much inflamed, and the gangrene evidently progress- 
ing. Having had a case some four weeks before, in which gan- 
grene followed a simple fracture, and was cured by Lack., against 
the advice of my colleague, Dr. D. S. Trites, I removed a por- 
tion of the foot, below the ankle-joint. The great toe, and the 
one next to it, not being involved, were left in place. The line 
of the gangrene was so irregular, that it was found impossible to 
save the toes unless a portion of this gangrene was left on the foot. 
The piece left was about as large as a silver half-dollar. Six 
days afterwards this spot sloughed out, and under the use 01 
Lack. 200, dry, on the tongue every third day, the further 
invasion of the disease was stopped. This was in every way in 
direct violation of all standard teaching, as the amputation was 
not above a joint, and was performed before the disease was 
checked. Still the boy recovered, with a useful foot, in as short 
a time as could be expected. At the bottom of the record of 
this case, in my "case-book" for 1865, occurs this passage, 
which will bear repeating : " A perfect cure resulted, and another 
great fact is thus fully proved — viz., that allopathic surgery, and 
allopathic rules, are only suitable to allopathic medicine; what 
we can do in surgery, we do not yet know." 

Gangrene of external parts, one would suppose, is always 
easily diagnosed, but such is not the case. Strange as it may 
appear, eminent surgeons have actually mistaken bad cases of 
ecchymosis for gangrene. But of course this does not often 



Bed- Sores. 375 

occur. Gangrene may generally be known by a change of color 
in the part, it becoming generally first livid, then darker, until it 
reaches black, or almost so. There is always more or less loss of 
sensibility, and usually absence of pain, although, as noticed when 
speaking of the curable condition, there may be a little pain, or, 
to speak more properly, there is that indescribable sense ot 
uneasiness, or that dull, indistinct pain, noticed when speaking 
of congestion. 

But this all relates to gangrene of external parts. Gangrene 
of internal organs may result from a contusion, from congestion, 
inflammation, etc., pretty much as in external parts, under nearly 
all circumstances ; its existence is more properly suspected than 
determined. One of the first signs or symptoms of its approach 
is a total or partial disappearance of an already existing pain, 
but with no corresponding improvement in the patient's general 
health. This, of course, is not a reliable sign, as the same thing 
occurs in the invasion of an internal organ by suppuration, only 
in this instance a throbbing or pulsating pain succeeds to the 
former. The patient in these cases grows weaker and weaker, 
and unless relieved speedily dies. 

The diagnosis, then, is usually sufficiently easy, but it may, and 
has occurred, that a part is condemned and amputated when in 
reality the vitality is only lost to outward appearances, and ulti- 
mate recovery might ensue from a more persistent use of reme- 
dies. Do not be in too great a hurry to pronounce an unfavor- 
able opinion in these cases. 

The prognosis, of course, in nearly all of these cases, is apt 
to • be extremely unfavorable ; the chances for recovery are often 
slim, and though the patient may not require an operation, yet it 
is well to keep the possibility of such an event being necessary 
constantly before him, so that it will not be altogether unex- 
pected. 

Bed - Sores. 

Bed-sores are very troublesome affairs that are quite common, 
and will be found very difficult to manage. They may occur in 
spite of any precautionary measures, but can often be prevented 
by attention to cleanliness, and the avoidance of long-continued 
pressure. One indispensable thing, is to keep the bed dry ; this 
requires careful nursing. Bed-ridden people are those oftenest 



376 Gangrenous Diseases, 

affected ; by this I mean those who have been confined to the 
bed for a long time, and mostly in cases where one position has 
been long maintained. Here the natural discharges require con- 
stant attention to the bed-clothing. They are ulcers, then, caused 
by a long-continued pressure. on one point. In appearance they 
are an inflamed patch of skin, becoming soft and doughy, until 
finally a tough, grayish-looking slough is formed, which exudes 
thin, corrosive pus. On the elimination of this slough an ulcer 
is formed, commonly deep, but sometimes shallow, taking on the 
healing process slowly. They are not of the indolent variety of 
ulcer, but seem rather to depend upon the low state of the general 
system necessary to their formation. Cases have occurred in 
which the muscles, and even the bones, are exposed. Such cases 
are more serious than ulcers of the same size under other condi- 
tions, chiefly from the low state of the general health. There 
are few diseases that will be found so difficult to cure as this ; it 
requires patience and perseverance. Allopathy recommends 
numerous washes and ointments, which are adopted by many 
homceopathists ; they ought to. know that the cure is actually 
retarded by such means. Use remedies in attenuation, and give 
them internally, and the higher the better. ' The first thing to 
be done is to devise means for the relief of the pressure exerted 
on the part. If it can be procured, a water or air-bed is the best 
thing known. Should the patient be unable to get one, pillows 
and clothes should be so disposed that the end in view may be 
attained. Many other preventive measures have been published, 
prominent among them is the application of borax and spirits of 
wine, under the supposition that it hardens the skin. This seems 
doubtful to me ; I should rather think it would favor the forma- 
tion of such sores. Never touch them with caustic, the knife, or 
any instrument ; no good can come of it. Caustics are particu- 
larly objectionable, as they form a new slough, which, on separa- 
ting, leaves the original ulcer larger. 

Phagedena. 

Sloughing phagedena is also known as hospital gangrene, 
and in civil practice is extremely rare. I have never seen but 
one case, and that being a dispensary patient, was lost sight of. 
The characteristics are unknown to me from personal experi- 



Phagedena. 377 

ence, and so shall quote Erichsen rather extensively. It " is a 
disease characterized by a rapidly destructive and spreading ulcer, 
covering itself, as it extends, by an adherent slough, and attacking 
open sores and wounds. It used formerly to desolate civil hos- 
pitals, but thanks to the sanitary measures that are now so 
generally adopted in these institutions, it has almost disappeared 
from them, though still an outbreak of it occasionally takes place." 
" When sloughing phagedsena invades a wound that is previously 
perfectly .healthy, the surface of the sore becomes covered with 
gray soft points of slough, which rapidly extend, until the whole 
of the ulcer is affected. At the same time it increases rapidly 
in superficial extent, and commonly in depth ; the surrounding 
integument becomes oedematous, swollen, and of a livid red color ; 
the edges of the ulcer are everted, sharp-cut, and assume a cir- 
cular outline, and its surface is covered with a thick, pulpy, 
grayish-green, tenacious mass, which is so firmly adherent to the 
sore, that it cannot be wiped off from it, being merely moved or 
swayed to-and-fro when an attempt is made to clean it. There 
is usually some dirty, yellowish-green, or brownish discharge, and 
occasionally some bleeding; the pain is of a severe burning, 
stinging, and lancinating character, and the fcetor from the surface 
is considerable. The ravages of this disease, when fully devel- 
oped, are very extensive. The soft parts, such as the muscles, 
cellular tissue, and vessels, are transformed into a gray, pulpy, 
mass, and the bones are denuded or necrosed. The larger blood- 
vessels resist the progress of the disease longer than any other 
parts, but may at last be exposed, pulsating at the bottom of the 
deep and foul chasm. There is little risk of hemorrhage taking 
place, however, in the early stages; but when the sloughs are 
separating, an artery may give way, and bleeding to a dangerous 
or fatal extent may ensue. Blackader has described an ulcer- 
ated form of this affection, in which a vesicle containing a bloody 
ichor forms, with a hot, stinging pain ; this breaks, leaving a cir- 
cular ulceration about the size of a split pea. The ulceration 
once formed, rapidly extends by sharp-cut edges into the sur- 
rounding integument. 

"The constitutional symptoms are inflammatory in the first 
instance, with a tendency to asthenic and irritative fever as the 
disease advances." Some authors dispute this, claiming that the 
local symptoms occur first. Mr. Erichsen, however, seems to 



378 Gangrenous Diseases. 

have the mass of the profession agreeing with him ; at all events 
that is the homoeopathic doctrine. 



Carbuncle. 

Carbuncle is a disease peculiar to people of a debilitated, 
broken-down constitution, and attacks them usually about or past 
the middle period of life. It is but seldom seen on the extremi- 
ties, or what is more singular, on the anterior surface of the body. 
The back of the neck is the usual seat. When it is situated on 
or near the head, or when it is of large size, the patient may die, 
passing into a typhoid condition. 

Carbuncle begins with inflammation, swelling, and some pain; 
the swelling is flat, circular, and of a dusky red hue ; usually it is 
but very slightly elevated above the surrounding skin. When 
sloughing is about to occur, the skin covering it becomes darker, 
undermined, and finally breaks down around the edges, leaving 
fissures through which exudes a thin, badly-colored, unhealthy 
pus. 

The points of distinction between boils and carbuncles are 
sufficiently well marked to prevent the possibility of confusion. 
Boils have a small slough, and copious discharge of pus ; carbun- 
cles have an immense slough, while the suppurative action is mild 
or deficient. Again, boils are elevated above the surrounding 
integument considerably, and are of a conical shape ; carbuncles 
are nearly always on a level with, or but slightly raised above the 
skin, and are flat. These formations vary in size from one or two 
inches in diameter, to six, or even more. They seldom attack 
young people, or those of a robust habit. 

In spite of the homoeopathic authorities against it, there is noth- 
ing so effectual when conjoined with proper treatment — as early 
crucial incisions, passing through the whole extent, depth and 
breadth of the mass. 

Boils. 

Boils are well known to all physicians, and need but little 
mention. They are sometimes called " furunculus " or " abscess 
nucleata" According to Laurie, "a boil is a round, or rather 
cone-shaped, hard elevation, of different sizes, slowly inflaming 



Special Therapeutics. 379 

and suppurating, discharging matter generally at first tinged with 
blood, but still retaining a portion of morbidly altered cellular 
tissue, which may form the nucleus of other elevations after those 
which have appeared first have healed." The causes are a pecu- 
liar constitutional tendency. Boils are, however, frequently 
critical, as in gout, following acute fevers, in eruptive diseases, 
and sometimes forming the termination of chronic exanthemata. 

Treatment. — In the treatment of the sloughing phagedena, it 
may be necessary to employ Nitric acid to stay the further exten- 
sion of the ulcerative process. I should be more inclined, how- 
ever, to trust to my remedies alone. Boils, I believe, should be 
opened as soon as you see them, whether there be pus or not. 
Should suppuration follow, an outlet being already made, there 
will be less pain. It has been my experience that when a boil is 
opened in the earliest stages, before the formation of pus has 
commenced, the swelling will subside and a cure result very often. 

The remedies that are oftenest used, are as follows : 
Gangrene: Humid. — Chin., Hell., Phos. 

Hot. — Aeon., Ars., Bell., Muriat. acid, Sabin., Secale. 

Cold. — Ars., Asa/., Euphorb., Lach., Plumb. , Secale, S/l., 

Squilla, Bell., Con., Merc, Ranunc. bulb. 

of the Nose. — Secale. 

of the Buccal Cavity. — Ars., Lach. 

of the Sexual Parts. — Ars., Canth., Plumb. , Secale. 

of the Scrotum. — Plumb. 

of the Penis. — Canth., Plumb. 

of the Uterus. — Secale. 

of the Arms. — Secale, Ranunc. 

of the Lower Limbs. — Secale. (Lach., G.) 



Sloughing Phagedena : Ars., Aur., Hep. s., Lach., Mere, 

Mezer., Nit. ac., Tart, em., Sil., Sulph. 

of the Nose. — Aur., Merc. 

on the Chest. — Mezer., Sulph. 

on the Back. — Ars., Merc. Sil., Sulph. 

on the Arms (upper). — Ars., Mezer. 

on the Arms (lower). — Merc. 

on the Hands. — Merc, Sil., Sulph. 

on the Fingers. — Merc, Sil., Sulph., 

on the Thigh. — Merc, Mezer. 



380 Gangrenous Diseases. 

Sloughing Phagedena : on the Leg. — Mere, Mezer^ Sil. 

on the Foot. — Ars., Si'/., Sulph. 

Boils: Aeon., Am., Bell., Hefiar. s., Mere., Sulph. 
Carbuncle : Ars., Am., Bell., Lack., Merc., Sulph. 
Bed-sores: Am., Ars., Lack., Plumb. 

Aconite nap. Deadly paleness of the countenance, and shud- 
dering ; the part first swells, and then assumes a blackish color ; 
sleeplessness, tossing about from side to side; chilliness if uncov- 
ered in the least ; excessive thirst ; slight perspiration, and hard 
accelerated pulse ; cool sweat in the palms of the hands ; coldness 
of the feet as high as the malleoli, with sweat on the toes and 
soles of the feet. 

Arnica mon. Hard, hot, and shining swelling of the parts 
affected ; gangrene following contused wounds ; thirst before the 
fever; pain in the periosteum of all the bones, as intermittent 
fever ; pain in the cartilage of the ear, as if the parts had been 
contused ; swelling of the nose, with a feeling as if from ulceration 
in the nostrils; tendency to boils, frequently returning; carbuncle 
with fine pricking of the skin. 

Arsenicum alb. Great weakness, and emaciation ; cannot take 
even a few steps without sinking ; carbuncle which is the seat of a 
deep burning pain, and particularly useful just before the slough- 
ing process is commencing; anasarca, or cedematous swelling of 
the part; general coldness with parchment-like dryness of the 
skin ; thirst, drinking little at a time, but often ; gangrene accom- 
panied by fetid diarrhoea; carbuncle arising from contagion; 
coldness followed by heat. 

Asafteiida. Dark-red and hot swellings; cold swellings; bright 
raw appearance of the wounds, covered with a crust of tenacious 
lymph, with transparent lymph-like pus, and sensitive to the 
touch ; coldness and dryness of the skin, with accelerated pulse. 

Alirum met. Gangrenous diseases with cedematous swelling 
of the part ; very sensitive to cold ; low-spirited, with desire to 
commit suicide. 

Belladonna. Fiery redness of the swelling, and of the sur- 
rounding skin, even erysipelas ; dry, hot skin, thirst and headache ; 
erysipelatous swellings, becoming indurated, and afterwards mor- 
tifying, accompanied by glandular swellings ; extreme sensitiveness 
to the slightest touch ; secretion of bloody ichor. 

China Off. Emaciation; naturally attenuated limbs, which 



Special Therapeutics. 381 

become bloated and swollen ; hard, red swellings ; putrid ichor ; 
pale, sunken or clay-colored face ; bed-sores in people who are 
much debilitated from excessive though natural discharges. 

CantharideS. Ulceration and gangrene after exanthematous 
diseases ; frequent paroxysms of feverish coldness ; pulse hard 
and full, or small and frequent ; nervous irritable ; loss of thirst. 

Conilim mac. Exhausted and faint, as if paralyzed ; gangrene 
from contusions ; the glands are swollen and indurated ; feeling ot 
heat in the whole body; perspiration all over; pulse unequal; 
depression of spirits. 

Euphorbilim. Inflammation and swelling, followed by cold gan- 
grene ; chilliness of the whole body, shuddering. 

Helleborus nig. Pale color of the skin; sensation in the smaller 
parts as if too heavy and as if pressed asunder ; general perspira- 
tion ; slow pulse ; constrictive sensation in the nose. 

Hepar SUlph. Boils on the head and neck, very sore on con- 
tact, and when lying on them ; hard, full and accelerated pulse ; 
perspiration easily excited; unhealthy readily-suppurating skin. 
This remedy is invaluable in promoting or hastening the secretion 
of pus. 

Lachesis. Sensation as if hot air were pouring through the 
knee-joints ; gangrenous ulcers on the legs ; pulse is small 
and weak, but accelerated ; internal sensation of heat with cold 
feet; skin changes to bluish, red or yellow; carbuncles with pur- 
ple colored surroundings, and many smaller boils around them ; 
gangrenous ulcers and blisters. 

MercurillS Viv. Inflammation and swelling of the glands of 
the neck; pulse irregular; boils, and carbuncles; carbuncles that 
are very foul and destructive ; cannot bear the heat of the bed ; 
the pains are not ameliorated by either hot or cold applications, 
both seeming to increase the sufferings. Before suppuration 
begins in a boil, this remedy will often cause the swelling to dis- 
appear. 

Mezereum. Burning of internal parts, with external chilliness; 
sensitiveness to the cold air; pulse full and hard; perspiration 
during sleep, followed by a chill, with no previous heat. 

Muriatic acid. Putrid, gangrenous ulcers on the lower extrem- 
ities ; great sensitiveness to the dampness ; pulse weak and slow ; 
chilliness and shuddering; "blood-boils"; oedema of the part. 

Plumbum. Carbuncle on the back of the neck, with tension 



3§2 Gangrenous Diseases. 

when moving the head ; oedema ; pulse very variable ; chilliness ; 
perspiration cold and clammy; small wounds easily suppurate; 
sensitiveness of the skin to the open air. 

Ranunculus bulb. I can find no indications for the use ot 
this remedy, notwithstanding it is recommended by many of our 
writers. 

Sabina. Red shining swelling of the affected part ; pulse is 
unequal ; violent beating of the veins ; insupportable burning heat, 
with restlessness in the whole body. 

Secale COr. Inflammation and gangrene of the uterus ; gan- 
grenous deadness of the fingers ; swelling of the hands with black 
pustules; senile gangrene of the feet; pulse remains unchanged; 
gangrenous blood vessels. 

Silicea. Boils on the neck and in the arm-pits, with glandular 
swellings and suppuration ; " blood-boils " and warts on the arms ; 
also on the thighs and calves; pulse small, hard and rapid; 
carbuncles, and bed-sores. 

Squill a marit. Has been used with some success in cold 
gangrene. 

Sulphur. Bed-sores with gnawing pain ; red-shining swelling 
of the toes ; pulse full, hard and quick ; sensation as of a band 
around the part; putrid ulcers, turning to gangrenous sores, and 
sloughing phagedsena. 

Tartar emet. Has been used occasionally for sloughing pha- 
gedaena. 

The indications above given are, of course very meagre. In 
selecting the remedy, compare this chapter with that on ulcers. 

Note. — A gentleman informs me that he has frequently aborted 
boils and felons by applying the bruised blue-flag, (Iris vers.) 
using the whole plant. 



Tumors 38 



TUMORS 

INNOCENT TUMORS, SEMI-MALIGNANT TUMORS, 
CANCEROUS TUMORS. 

Tumors in general are described by Dunglison to be "a 
rising, or prominence, of a greater or less size, developed by a 
morbific cause in some part of the body." I have italicized the con- 
cluding portion of this quotation, to show that the idea of a 
" local disease " is a visionary one. 

The whole subject has been divided into three great classes — 
1st, Innocent; 2nd, Semi-malignant; 3rd, Malignant. 

Innocent tumors are sometimes known as " benign," or "non- 
malignant." We have three general varieties of these tumors — 
1st, the encysted form; ?nd, those formed by a simple increase in 
size of already existing structures. These differ from simple 
hypertrophy, in having a distinct outline, and being prominent 
above the remainder of the part, involving only a portion. 
Hypertrophy, on the contrary, is a uniform enlargement of the 
whole part or limb, still retaining its proper shape. 3rd. Those 
formed by a growth of an existing structure, but never found 
normally in the situation occupied by the tumor. Among the 
first class we number the " atheromatous " and " cystic " tumors. 
Under the second, " warts," "polypi," " glandular," "fatty," "vas- 
cular," " nervous," and " bony " tumors. The third variety em- 
braces the different " fibrous " tumors. Some of these, however, 
are semi-malignant, as will be shown in the second section. 

This class of tumor derives its name of innocent, or benign, 
from the fact that they do not contaminate nor implicate neigh- 
boring structures, do not return after having been removed, and 
do not cause death or inconvenience, only (1st) when they com- 
press vessels or canals, (2nd) when by their pressure the bones or 
other tissues in the vicinity are absorbed, and (3rd) when their 
great size and weight wear out the patient. The different varieties 
we will mention are eleven in number, as follows : — " Atheroma," 



384 Tumors. 

"cysts," "warts," "condylomata," "sarcoma," "hcematoma," 
" polypi," " glandular," " fatty," " fibro-cellular," and " fibrous." 

1. Atheromatous Tumors. — This is a tumor formed of a cyst, 
and containing matter like pap, or "bouillie." They are met with 
in almost any part of the body, but are most common on the head. 
They may exist in any number, as many as thirty or forty being 
found in one case on the head ; the size may be from that of a 
pin's head, to that of an ordinary orange. They are painless, 
but, as Erichsen says, they may occasion uneasiness by compress- 
ing neighboring nerves. Usually they grow slowly, but occasion- 
ally, after remaining nearly stationary for a long time, they sud- 
denly grow rapidly. The contents are not invariably such as has 
been stated above ; sometimes it is cheesy, again creamy, dry, 
and laminated, or it may be semi-fluid, and of a brown, green, or 
blackish color. They sometimes terminate by inflammation, suc- 
ceeded by suppuration, which in turn is followed by the formation 
of a large ulcer, which will be found very obstinate and trouble- 
some to treat. The so-called " horns " are frequently the result 
of these tumors ; the process by which they are formed is thus 
described by Erichsen : " If left untouched, it occasionally, 
though rarely happens, that the sebaceous matter exuding through 
an aperture on its surface, forms a kind of scab or crust, which, 
by a process of sub-deposition, becomes conical ; and being 
gradually pushed up from below at the same time that it assumes 
by exposure a dark-brown color, forms an excrescence that looks 
like a horn, and is usually considered to be of that character." 
This is no doubt true of horns formed by these tumors, though 
the same formation has been met with in other diseases, and 
seems then to be due to some other process. 

2. Cysts. — These are sacs without any outlet, that may be ap- 
parently new formations, or normal ones abnormally distended. 
It may then be caused by the accumulation of fluids in such cavi- 
ties that are unprovided with an opening; the bursas are frequently 
enlarged from this cause. The structure and density of the walls 
of these cysts varies greatly ; they may be as thin as the arach- 
noid, or dense and fibrous. This form of tumor is most common 
in those parts where bursse naturally exist. When they are 
of a new formation, the sheaths of the tendons, and the celk 
ular tissue are their chosen seat. They vary in size from that of 
a mustard-seed to one weighing many pounds, as in the case of 



Tumors. 385 

"ovarian cysts." The contents may be fluid, semi-fluid, or jelly- 
like, and even solid; the same variety exists in regard to color — 
from a limpid, colorless fluid, to brown, or even black. We recog- 
nize two forms of cysts, the " simple " and the "multilocular." 
The simple, or, as they are sometimes called, " serous cysts," are 
found in almost any part of the body ; they are composed of a 
thin wall, and filled with fluid. Multilocular cysts are those 
composed of a number of simple cysts, joined together in one of 
two ways : one form is a number of simple ones pressed together, 
the other is one large cyst, with a number of smaller ones growing 
directly from it. The ovaries are more constantly the seat of these 
formations than any other part of the body. The contents vary 
greatly, as said when speaking of cysts in general. It is in the 
simple form only that we find colorless fluid ; in the other, the 
contents may be — anything. "Compound" and " proliferous " 
are terms applied synonymously to the multilocular cysts. Old 
authors speak of the "binocula," but modern writers include them 
all in one term. 

3. Hcematoma. — This is a cyst, differing, however, from those 
mentioned above, in containing fluid blood. Sometimes a vein 
becomes occluded, and from the consequent distension of its 
walls, a haematoma is formed. Transfusion of blood into an already 
existing cyst is frequently met with. Transformation from a 
nevus is also often the cause. These cysts are often, from their 
peculiar appearance, mistaken for cancer of the encephaloid 
variety ; it requires some care, then, to make a correct diagnosis. 
These three tumors should not be called separate diseases ; the 
only difference that I am able to discover is in the contents. 
They should be considered as different forms of the same disease. 

4. Warts — Condylomata. These two terms apply to the same 
diseases in reference to their locality ; when the skin is the seat, 
they are termed warts ; when situated on the mucous surfaces, the 
latter term is employed. Speaking of warts, Erichsen says, 
"these essentially consist of an increased deposit of laminated 
cuticle, usually with some augmented vascularity of the cutis." 
Warts are hard, horny, and usually conical projections, rarely sen- 
sitive, and occurring on any part of the body, and in almost any 
number at one time. Occasionally they appear as large flat clus- 
ters, and are rather painful ; sometimes again they are soft, but 
usually they present the characteristics noted above. The hands 



386 Tumors, 

are oftener affected than any other part. Condylomata, as said 
before, are found on the mucous surfaces, are soft, flatter and usu- 
ally of a whitish color, are occasionally sensitive, and likewise 
occur in great numbers. These tumors are very vascular, and 
bleed readily on the slightest touch. They are sometimes spoken 
of as "mucous tubercle." Dunglison says that "condylomata 
arises from the application of syphilitic virus." Erichsen appears 
to think differently. The general impression at this day is, that 
syphilis is not the only cause for their appearance ; they occur in 
many cases spontaneously, and then again from a multitude of 
other diseases. There is a variety, however, which is known as 
venereal condylomata. 

Cheloidis a growth closely allied to warts ; Erichsen says, "it is 
a peculiar pinkish-white fibro- vascular tissue, which is commonly 
met with in old cicatrices as an outgrowth of these, and not unfre- 
quently recurs after removal." 

5. Sarcomatous tumors. These growths are nothing more than a 
hypertrophy of " fibro-cellular element," and are moderately rapid 
in their growth. Abernethv had made these tumors a study, and 
has given us a long list of varieties, which would take up too much 
space to mention. Actually, they are fleshy tumors ; on examina- 
tion they look like muscle or skin, depending upon their situation. 
They have attained an enormous size ; one case is reported in 
which a mass of this kind was removed that weighed one hundred 
pounds. They are painless, smooth, a little doughy in feeling, non- 
elastic, movable, and sometimes pendulous or pedunculated. 
Pendulous sarcomas is the character of the tumor usually known 
as a " wen. " In the earlier stages of their formation; when quite 
small, pressure will frequently cause their disappearance, but this 
is not practicable when they have attained any size. In Novem- 
ber, 1865, I removed a tumor from a lady's thigh, that was so 
different from anything I had ever seen, that it was hard to tell 
what it was. It is in my " case-book" for that year as a " medul- 
lary sarcoma," (Abernethy's classification.) It was a pyriform 
shaped body, as large as a good-sized fist, and of a dark-blue color; 
very vascular, and warmer than the surrounding skin. It hung by 
a pedicle as large as the little finger in diameter, and about two 
inches long. After removal, the section showed it to be composed 
of a number of fat globules, enclosed in a fibrous net- work, which 
in turn was enclosed in a thin membrane. These were surrounded 



Tumors. 387 

by the skin, but had no attachment to it whatever ; merely laying 
loosely in it. It was nourished by a large artery nearly as large as 
the digital branches, and accompanied by a vein. There was no 
return of the disease, 

6. Polypi. This form of tumor is a pendulous and pedunculated 
mass springing from the mucous membrane ; it may be found on 
any mucous surface, but is most common in the nasal fossae and 
the uterus. Dunglison says that they may be innocent or malig- 
nant in their character, the latter degenerating into true cancer, 
and readily distinguished from the benign by their being quite 
painful, readily bleeding, etc. The innocent or benign class is 
divided by authors into a great number of varieties, the names of 
which indicate the characteristics quite easily. This sub-division 
is of but little importance to us, or even to the allopaths ; Erich- 
sen himself only noticing two of them. In speaking of polypus, 
he says, " the true mucous or gelatinous polypus is composed of the 
elements of this membrane expanded and spread out, and consists 
of a loose fibrous stroma covered by epithelium more or less dis- 
tinctly ciliated, the cilia being often beautifully seen, when recent 
specimens are examined under the microscope. The so-called 
fibrous or medullary polypus consists of other forms of tumor grow- 
ing from and covered by mucous membrane." From this it would 
appear that polypi are not a class of tumor made up of several 
varieties, but a distinct form of tumor found on the mucous sur- 
faces. All polypi grow rapidly, the mucous or true variety espec- 
ially so. This is spongy, soft, bleeding readily when touched, and 
causing extensive mischief by its pressure, to the bones and other 
neighboring parts. The true polypus then, without being cancer, is 
a malignant tumor, as it recurs after removal: although not contam- 
inating neighboring parts with any specific poison, it still injures 
them if in no other way, by pressure. They are generally described 
as being a " brown or reddish-purple " mass, but they may also be 
black or gray. The black variety is not common ; I have seen but 
one or two cases, and considered the color to be dependent upon 
some change that might be going on, and not its proper color. 
Occasionally they have been seen as a bluish tumor. Although 
of but little importance, the classification of Dunglison may not 
be unappropiate. He calls them hard, soft, spongy, vascular, 
granular, mucous, fibrous, fleshy, carcinomatous or schirrous, etc. 

7. Glandular Tumors. — These tumors are nothing more nor less 



388 Tmnors. 

than a chronic enlargement and induration of the glands, in whole 
or in part. For this reason the consideration of them ought to be 
referred to the chapter on scrofula, as they are more of a hyper- 
trophy than a tumor. They are produced by inflammation usually, 
though it has been said that they have been unaccompanied or 
preceeded by this condition. It seems, however, to be an impos- 
sibility. 

8. Fatty Tumors. — These are the most common of all the forms 
of tumors, and constitute a very important class of these diseases. 
They may be found in nearly any part of the body, at almost any 
age, and of all sizes. The cause (remote) is usually obscure; a 
blow, the pressure of some article of clothing, as the suspenders, 
or any long-continued pressure will be usually found the exciting 
cause. A case I operated on three years ago had one on the 
shoulder that was congenital, and probably hereditary, as her 
mother had one of the same character. These tumors have been 
divided into two great classes : the " circumscribed," or true fatty 
tumors (lipoma), and the " adipose," or diffused. This last form 
is not a disease, nor is it a tumor, properly so-called. It is quite 
amenable to homoeopathic treatment. It is nothing more than 
masses of fat in situations already sufficiently well supplied and 
distinguished from the normal quantity only by knotty protuber- 
ances not well defined in outline. 

The true or " circumscribed " form has been divided into two 
varieties, the " lipoma? and " cholesteatoma. " The former is the 
most common form of this tumor, and is made up of yellow, oily 
fat, and cellular tissue more or less firm, invested in a thin cap- 
sule, not adherent, but lying loosely and unattached. In form 
they are more or less lobulated, and not unusually send out irreg- 
ular prolongations in different directions. Sometimes these lipoma 
slip down into other situations from that they originally occupied. 
Although these tumors are usually found to be unattached to the 
capsule or surrounding parts, it sometimes is found otherwise. A 
lady came under my care four years ago, with a lipoma on the cap 
of her right shoulder. She had been under the care of a " cancer 
doctor," and it being pronounced cancer, was " duly and legally 
cauterized " and poulticed. On removing the mass, the base and 
a portion of the edge was found to be tightly adherent to the skin 
and muscles, requiring considerable dissection to free it. This, 
perhaps, was to be credited to the " active treatment " she had 
undergone. 






Tumors. 389 

The cholesteatoma is " a smooth, laminated, white and dry fatty- 
mass, contained in a cyst, and apparently composed of crystalline 
fat enclosed in meshes of cellular tissue." 

9. Fibro-Cellular Tumor. — These tumors are found in the case 
of persons who in other respects are perfectly healthy. They 
form rapidly, and grow to enormous sizes. The scalp, scrotum, 
labia and thighs are the usual seat of the affection. They are 
painless, soft, elastic, round and smooth, of a yellow color, con- 
taining a large amount of serous fluid, which can be squeezed out 
in large quantities, and are invested in a thin capsule. 

10. Fibrous Tumors. — With these tumors I have had no expe- 
rience, having never seen but one case, and that occurring in the 
practice of a friend, it will be more satisfactory if I quote at length 
from Erichsen, he giving the best description I can find in the 
smallest space: "They are met with in various situations, as in the 
testes and mamma, uterus and antrum, about joints, in the perios- 
teum, in the subcutaneous cellular tissue, and in connection with 
nerves. The situations in which they are most frequent, and 
where their structure is most typical, are in the neck, especially 
in the parotid region, in the uterus, and in the antrum. In shape 
these tumors are irregularly rounded or oval ; they are smooth, 
painless and movable ; they grow slowly, but may attain an enor- 
mous size, equal to that of a cocaonut or watermelon. * * * 
They have been found, however, weighing as much as seventy 
pounds. They are almost invariably single, and when cut into 
present a white, glistening, ligamentous structure, being composed 
of neucleated fibres like those of ligamentous tissue. These 
tumors may remain stationary for years, and this is the condition 
in which they are oftenest presented to the surgeon. Eventually, 
however, they are apt to undergo disintegration, becoming infil- 
trated, oedematous and softening in the center, or at various points 
of the circumference; they then break down into a semi-fluid 
mass, the integuments covering them inflame, slough, and an 
unhealthy suppuration, mixed with the disorganized portions of 
the tumor, is poured out, leaving a large and unhealthy slough 
chasm from which fungus sprouts may shoot up ; readily bleeding 
on the slightest touch, and giving the parts a malignant appear- 
ance ; the patient eventually falling into a cachectic condition, and 
becoming exhausted from the haemorrhage and discharges. In 
other cases again, these tumors may degenerate into a spongy, 



390 Tumors, 

calcareous mass of a brownish color, and hard consistence, but 
they never undergo proper ossification. More rarely the interior of 
these growths softens and undergoes absorption, so as occasion- 
ally to form cysts of large size, containing fluids of various shades 
of color." 

Semi-Malignant Tumors. 

Semi-Malignant Tumors are those which, while they are 
innocent in appearance, are malignant in their course. That is, 
they are apt to return after removal in the same place or in some 
other, and may contaminate or implicate adjacent structures. 
This is the usual classification, but I speak of semi-malignant 
tumors as those which do recur, and are malignant in everything 
save the presence of cancer cells. Cancers are malignant tumors, 
and are nothing else in my opinion. The varieties included in 
this class are : the malignant fibrous, recurring fibroid, the fibro- 
plastic, and enchondromatous. 

i. Fibro-Plastic Tumors. — Sometimes termed "myeloid," and 
is the " albuminous sarcoma " of Abernethy. These are com- 
monly without pain, elastic in feeling, smooth, occurring in young 
people, and are not apt to return after removal. On examination of 
a recent specimen, it will be found that on section they are trans- 
lucent, shining, of a greenish-gray, blue or pink color, and in most 
cases spotted by marks varying in color from a blood-red to a 
brownish, or sometimes of a livid hue. When these spots are in 
great numbers the appearance is one that would justify the term 
of sarcoma (or fleshy) applied to them by Abernethy. 

2. Recurring Fibroid Tumor. — In appearance, these tumors 
closely resemble the non-malignant fibroid ; they are, however, 
painful, and very often return after removal. If a microscopical 
examination be made, there will be seen to be a great difference 
from the non-malignant tumor. Every succeeding recurrence of 
the tumor will be found to be more aggravated in malignity than 
the preceding. Paget says the examination of a tumor of this 
kind which resulted in the death of the patient, presented " very 
narrow, elongated, caudate, and oat -shaped neucleated cells, 
many of which had sub-divided terminal processes. " They usually 
appear on the extremities, and may attain such an immense size, 
that amputation will be found necessary. 



Malignant Tumors, 391 

3. Enchondroma. — These tumors are often called " cartilagin- 
ous " tumors, and indeed are more commonly known by that 
name ; they may be either non or semi-malignant in their char- 
acter. When benign, they are small, hard, smooth, elastic, ovoid, 
round or flattened in shape, seldom attaining dimensions larger 
than an ordinary orange, and growing slowly and painlessly. The 
semi-malignant are widely different from the preceding, and do not 
as frequently occur. They may terminate in ossification, or break 
down into a soft fistulous tumor, discharging jelly-like matter, 
and assuming a sloughing character ; the integument covering it 
becoming inflamed, discolored and breaking down into fluctuating 
masses, which may be easily mistaken for cysts, and have fre- 
quently been opened under this impression. They may occur 
with or without connection with the bones, but most often the 
latter. The bones of the carpus and metacarpus, and sometimes 
the corresponding bones of the feet, are the most often affected ; 
when situated in these places, they spring from the interior of the 
bones ; when found in connection with, or growing from the short 
bones, they are seldom seen larger than a pigeon's egg, but if 
found on the larger long bones, as the femur, they may attain an 
enormous size. When cut into, they bear a strong resemblance to 
foetal cartilage, and this appearance gave them their name. The 
non-malignant variety are not apt to undergo this disintegration, 
usually becoming indurated, and eventually becoming ossified. 

Malignant Tumor. 

Cancer is one of the most terrible of all diseases ; under old- 
school management it is utterly incurable, neither their remedies 
nor the use of the knife are in the least successful. Homoeopathy 
has cured — and probably will again — many cases of all kinds of 
cancer, and though not certain in its results, it has done, and can 
do more than the other systems or so-called schools can do alto- 
gether. One reason, perhaps, why the treatment of cancer by 
medicine has not been oftener attempted by us, is the want of suf- 
ficient instruction, or rather literature, on the subject. It is true 
that enough has been written and published by different men on 
the subject, but it is scattered through our journals, and in its 
present shape is of little use to the profession at large. To collect 
the best of this material has been my task; and I would then 



392 Tumors. 

acknowledge my indebtedness to these writers for the material 
used in writing this section. Nothing remains to be done when 
your remedies fail; the knife can never eradicate the disease 
except in some form of encephaloid cancer. You only subject the 
patient to additional and unnecessary pain, and instead of giving 
him a " last chance" for his life, oftener take from him any chance 
at all ; the disease is almost certain to re-appear, and each time 
with more virulence than the preceding. Before going on to 
speak of the varieties of cancers, let us for a moment only con- 
sider the question of operation in such cases. It is the first duty 
of the surgeon to prevent the necessity for instrumental interfer- 
ence arising ; and if this is attempted to be done by medicine, and 
it fails, it is then too late to operate. On the other hand, if an 
operation be resorted to in the very beginning, extirpation of the 
tumor may be followed by a cure of the disease. For two reasons 
this operation is apt to be neglected: ist, difficulty of diagnosis 
at such a stage, and 2nd, the fact that patients rarely apply until 
the disease has made some progress. But if a removal of the 
tumor is determined upon, never by any means use plasters or 
caustics ; they are the weapons of the empiric and quack, and are, 
I may say, never successful. Sometime since I had a controversy 
with a physician who claimed to have cured a number of cases by 
these means, and in proof of his success cited two cases ; one of 
these he admitted had suffered from a return of the tumor, and 
the second came into my hands, and ultimately died from second- 
ary cancer, by glandular infiltration. When you operate, use the 
knife j cut wide of the apparent boundaries of the disease. The 
doctrine that denies the possibility of local disease, is strongly 
upheld in these cases ; the most careless student can readily see 
that the tumor is but the local manifestation or symptom of a gen- 
erally diseased body. But to proceed. 

Malignant tumors (or cancer ), are those which contaminate 
neighboring structures, return after removal, are accompanied by 
pain, and destroy life. Cancers have been divided into five vari- 
eties ; scirrhus, encephaloid, melanosis, colloid and the epithelial. 
It is a point to be borne in mind, that one or more of these forms 
of cancers may exist, not only in the same person at one time, but 
in one tumor. Thus scirrhus and encephaloid have been found 
in one carcinomatous breast. Let me say a word here on the 
nomenclature of these diseases. Homoeopathic writers very often 



Malignant Tumors, 393 

confound the words scirrhous and carcinomatous, either through 
carelessness or ignorance. We speak of cancers in general as car- 
cinomatous tumors, whether they be of one variety or the other. 
Laurie and many others, speak of scirrhus as being the tumor, 
and only employ the distinctive name to designate the ulcer. Now 
scirrhus is a distinct form of cancer. 

1. Scirrhus. Gross, in 1845, gave the following description 
of this tumor, and on examination, I have been unable to find one 
that is any better at this day : — " It is a hard, crisp, opaque sub- 
stance, of a light grayish color, with dull, yellowish, fibrous 
intersections, organized, liable to lancinating pain, occurring for 
the most part after the middle period of life, and passing sooner or 
later into ulceration." In short, it is a hard brawny-feeling tumor, 
calculated not only to destroy the tissues around it, but even the 
life of the individual. Erichsen's description is as follows : " A 
hard, craggy, incompressible and nodulated tumor, at first mova- 
ble and unconnected with the skin, but soon acquiring deep-seated 
attachments, and implicating the integument. It grows slowly, 
seldom attaining a larger size than an orange." It has a course 
to run, presenting two conditions, called the "occult" and "open." 
The ulcer resulting from scirrhus is a foul, fetid, destructive sore, 
progressing rapidly, accompanied by great increase of pain. Death 
results from a secondary deposit, either in the glands, when it is a 
reproduction of the scirrhus, or insome of the viscera, when it is 
of the encephaloid kind. Fleshy or young people, and women, 
die much sooner from it than the old, or lean persons. Scirrhus 
may occur singly, or in several parts of the body at the same time ; 
both conditions are common. An examination of a recent speci- 
men, will disclose the following peculiarities : It creaks under the 
knife ; on taking off a thin slice, it is found to be laminated, flexi- 
ble and elastic, and if dried, resembles horn. The extreme 
hardness of these tumors is not so perceptible when handled 
after removal, as they were when in situ; this is accounted by 
Walshe in " the escape of the fluids, and consequent loss of 
turgescence" Fibrous looking lines are seen to run all through 
these masses, starting from the center, and by Gross are said to 
be "the remains of the cellular substance of the affected part;" 
and this is probably correct. A creamy fluid is also observed on 
making a section, which is one of the most distinctive marks of its 
carcinomatous origin. When softened, the tumor resembles a yel- 



394 Tumors, 

lowish-brown, semi-transparent jelly. I have had but one case in 
which a scirrhus returned after removal, that any notes were made 
of, and from them I find on comparing them with others, that the 
method of reproduction is about as follows : When the glands are 
the seat of secondary deposit, the tumor is reproduced. But if the 
disease returns in the cicatrix, it is in the ulcerated form. A scar 
which has all along looked healthy, takes on a purplish appearance, 
and soon becomes swollen or raised above the surrounding skin. 
Later elevations, from the size of a pea to that of a walnut, appear 
in the substance of the scar, and along its edges ; these are of a 
light pinkish color, and are covered by a very thin, transparent skin, 
through which small vessels are seen branching out in every direc- 
tion. Shortly these elevations — which are cone-shaped — become 
flat on top, turn a greenish gray color, and become depressed ; a 
slough is thrown off, a deep ulcer of a fetid odor is formed, which, 
spreading rapidly, merges into the next one until all these small 
ulcers are joined in one large one ; or with several large ones, 
divided by narrow strips of skin. The pus is usually scanty, and 
thick; sometimes, however, thin and profuse. As these smaller 
ulcerations increase in diameter, they likewise increase in depth. 
2. Encephaloid, or Fungous Hozmatodes. — This is the most com- 
mon form of secondary cancer, and is likewise the most malignant, 
disgusting, and rapid in its growth. It has been met with in 
nearly every part of the body, but is most commonly found in the 
eye, ends of bones, testicles, and mamma. It commences as a 
tumor, which is usually soft and semi-fluctuating from the begin- 
ning, or, at all events, soon becomes so ; it is soft, elastic, lobu- 
lated, grows rapidly, and the skin enclosing it is covered with 
swollen, tortuous, blue veins. At first the skin is loosely attached, 
or quite non-adherent, but it shortly becomes adherent, and com- 
mences to change color; it becomes livid, inflames, assumes a 
dark color, and finally gives way. From out of this fissure spring 
fungous growths, attaining an enormous size, and bleeding pro- 
fusely. This may be considered the last stage of the disease, for 
death rapidly ensues. After these granulations spring up, the 
whole course of the cancer is more rapid, the secondary effects or 
deposits more marked, and the exhaustion consequent upon the 
hemorrhage, together with the speedily-developed cachexia, soon 
wears out the patient. As the deposits of scirrhus are apt to be 
encephaloid under certain conditions, so the deposits of encepha- 



Malignant Tumors. 395 

loid are often scirrhous. Erichsen says : " After removal, the 
tumor is found to be very vascular, displaying, on injection, a close 
network of vessels. On a section being made, it commonly pre- 
sents a soft, pulpy, white mass, closely resembling cerebral sub- 
stance. In other cases, again, its section has been compared to 
that of a boiled potato, or a piece of boiled udder. On a closer 
examination, its tissue will be found to consist of a stroma of deli- 
cate fibres, supporting the soft medullary, or brain-like structure ; 
this may be seen to be composed, in a great measure, of large 
quantities of corpuscles — nucleated, compound, and granular, fusi- 
form, angular, clubbed, or caudate, often with two terminations. 
This form of cancer is met with at any age, and in both sexes, 
neither is it peculiar to the human species, but is found in animals 
occasionally, as the horse, dog, and cow. It may exist alone, or 
be found with tubercle, scirrhus, melanosis, hydatids, and many 
other morbid growths. The encephaloid matter is deposited in 
the viscera, either primarily or secondarily, in three distinct forms 
— viz., the tuberoid, stratiform, and infiltrated. These, for general 
purposes, are sufficiently well described by the mere mention of 
the name ; at all events, want of space forbids entering too deeply 
into a description. Gross says : " It is very common to observe 
the successive, or simultaneous development of this disease in a 
number of organs or parts ; in fact, there is occasionally a marked 
encephaloid diathesis." There are some peculiarities about the 
appearance of this disease in the eye, that demands attention. 
Walton (" Ophthalmic Surgery ") says of it : " The earliest symp- 
tom that generally attracts attention is a shining, yellowish, and 
deep-seated reflection from the bottom of the eye, as if it contained 
a piece of metal ; this is best seen in particular lights, and some- 
what resembles the peculiar appearance of a cat's eye when seen 
in the dark. * * * As the disease advances, the cause of the 
metallic reflection becomes evident. It is now seen to be owing 
to a tumor, springing up apparently from the fundus of the eye, 
of an irregularly rounded form, generally divided superficially into 
two or three lobes, and traversed by one or two small blood- 
vessels, which ramify on its surface ; in color it varies from a deep 
orange hue to nearly white, the most usual being, perhaps, a 
bright canary yellow. This growth gradually increases in size, 
approaches the front of the eye, causing absorption of the vitreous 
humor, and presses upon the lens, which becomes opaque, and in 



396 Tumors. 

most instances is ultimately absorbed. * * * Towards the 
conclusion of this stage the eye is undergoing considerable tension 
from the internal pressure ; it feels hard, its motions are limited. 
* * * The cornea expands and becomes opaque, the sclerotica, 
thinned by absorption, allows the dark-colored choroid to shine 
through it, and is irregular in outline, rising into small, dark- 
colored knobs where the pressure has been most severe, or the 
absorption most rapid. In many instances it is so densely covered 
with large varicose vessels, that no alteration in color is percepti- 
ble. The eyelids now become oedematous, and the eyeball promi- 
nent, and, apparently, greatly enlarged in size. * * * This 
stage terminates in the escape of the fungus from the interior of 
the eye, and this may take place either through the cornea or the 
sclerotica. * * * The tumor, now released from pressure, 
rapidly increases in bulk, so as in a short time to distend the orbit 
and eyelids, and efface all appearance of the eye." Instances are 
recorded in which this tumor has attained a size equal to that of 
the head ; half as large as the head on which it is situated is a 
common size. 

3. Melanosis. — This form of cancer is closely allied to the en- 
cephaloid — that is, the minute structure is similar to encephaloid, 
but there is an abundance of pigmentary material, and the fungus 
masses are black, or nearly so. It is rarely seen as a tumor, but 
as a deposit in internal parts ; the eye, skin, sub-cutaneous cellular 
tissue, and sometimes, though rarely, the bones, are the places in 
which it is oftenest found. Gross says of it, quoting in part from 
Ljennec : " It is a homogeneous substance, very similar in its 
structure and consistence to a bronchial gland, of a deep black 
color, opaque, humid, and slightly unctuous to the touch. This 
substance; after a while, has a tendency to become soft ; the pro- 
cess by which this is affected commencing generally in the center, 
and gradually proceeding towards the circumference, until it is 
entirely broken up and dissolved. When this is accomplished, 
nature sets up an eliminating effort, the surrounding parts take on 
inflammation, and the heterologous matter is finally expelled, thus 
leaving a corresponding cavity, which either continues open, is 
lined with lymph, or else completely obliterated." It appears from 
this that this form of cancer is the most innocent, and is even 
rarely attended by a fatal result. He goes on to say : " No age 
nor sex seems to be exempt from this disease, though it is, without 



Malignant Tumors. 397 

doubt, much more frequent in the old than in the young. Nor is 
it confined exclusively to the human subject. * * * What is 
remarkable, this substance is much more common in white than 
in colored horses; and the same is true, I have reason to believe, 
in regard to cattle. * * * The color of melanosis, as might be 
expected, is considerably influenced by accidental circumstances, 
as the quantity of cruor and cellular tissue entering into its com- 
position. It may be said always to incline to black ; but not un- 
frequently it presents various shades of brown and yellow. * * * 
In its consistence, melanosis varies from the fluidity of ink to 
the density of fibro- cartilage." Erichsen, quoting from Sir 
Robert Carswell, says : " He arranged under the heads ot 
punctiform melanosis, in which the dark pigmentary matter occurs 
in the shape of minute points or dots scattered over a considerable 
extent of surface. The tuberiform, occurring in tumors which 
vary in bulk from the size of a millet-seed to an egg or an orange, 
always assuming a globular, ovoid, or lobulated shape, and being 
principally met with in the cellulo-adipose tissue, or on the surface 
of serous membranes. The stratiform and liquiform melanosis, 
which takes place principally upon serous membranes, or in acci- 
dental cavities, when the black pigmentary matter looks not unlike 
Indian ink." 

4. Colloid. — This is also called gelatinous, or alveolar cancer. 
These tumors are rarely seen as a distinct tumor, chiefly occurring 
in connection with scirrhus, or in some internal organ, hence it 
is rarely seen except on post-mortem examination. These tumors 
are made up of cells, the walls of which are of a fibrous character, 
and are filled with a clear, semi-transparent, yellowish, jelly-like 
substance, resembling honey. The jelly-like contained matter is 
very soft, but the whole colloid mass is firm and resisting ; it does 
not attain a very large size, but grows rapidly ; it is seldom seen 
in children. These tumors are sometimes developed in the bones, 
and also in the ovaries. The most common seat for them, how- 
ever, is the stomach, and, indeed, all through the alimentary 
canal. 

5. Epithelial. — This is called by many eminent men a malignant 
growth, but to me it has always appeared to partake of the semi- 
malignant form ; or, rather, from the fact that they very rarely are 
accompanied by secondary deposits, and may be removed without 
much fear of a recurrence, I consider them to be not true cancer. 



398 Tumors. 

However, as many of our best surgeons consider them malignant, 
it does not become me to differ from them. Like cancer, it has 
a tendency to ulceration, glandular complications, and may induce 
a cachexia ; but, on the other hand, it is comparatively painless, 
may be removed with safety, and does not cause secondary visceral 
deposits. It is frequently met with on the mucous surfaces, outlets 
of the body, and sometimes, though rarely, on the skin. They 
are usually pedunculated, and on section show epithelial scales, 
packed together in a globular, or a compact form. These cancers 
occasionally, indeed frequently, rapidly ulcerate, leaving a small, 
foul ulcer, which seems for a time to be as nearly as possible 
local. 

Treatment. — Tumors of either of the three classes are 
very amenable to treatment in the great majority of cases. It was 
some time before I could believe that treatment by remedies could 
ever be successful; that is, Xht power of our remedies to do this I 
did not doubt, but could not see how we could find symptoms 
enough to guide us in selecting that remedy. Now this has been 
made clear to me. You must leave the tumor as much as possible 
out of sight ; the symptoms of the tumor itself are few, and not 
worth much — the patient's ordinary habits, and the departure 
from the natural performance of all his bodily functions, the dis- 
position, and appearance, must all be taken into consideration. 
Use no external applications of any kind. And I have found the 
high attenuations the best ; in fact, from the poor success I have 
had with the lower in these cases, I have no hesitation in saying 
the low (d, 3d and 6th) cannot cure a tumor. As it is difficult to 
find many distinguishing local symptoms, I will give a rather larger 
" index " than usual : 

Non-Malignant Tumors: Cystic— Apis., Lach., Calc, Graphs 
Hep., Sil. 

Hcematoma. — Am., Ars., Rhus. 

Warts. — Thuja, Caust., Con., Lye, Merc, Natr. mur., 

Sulph. 

Condylomata. — Thuja; Cinnabaris ? 

Sarcoma. — Phos., Phos. ac., Calc, Sulph. 

Polypi. — Calc. c, Calc. phos., Am., Pry., Dulc, Graph., 

Led., Lye, Sulph. 

Glandular. — Pell, Lye, Merc, Nit. ac, Phos., Rhus, 

Sulph., Ars., Paryta, Pry., Calc, Cham., Con., Dulc, Graph., 
Hep., Kali c, Nat. c, Puis., Sil., Thuja, 



Special Therapeutics. 399 

Non-Malignant Tumors: Lipoma.— Calc. carb., Calc. phos. 

Cholesteatoma.— Baryta c, Calc. carb., Calc. phos., Lye. 

Fibro-cellular — Ac. acet., Ac. nit., Bell., Dulc, Merc, Sil. 

Fibrous. — Phos., Phos. ac. 

Semi-Malignant Tumors: Fibro-Plastic. — Ars., Bry., Loch., 
Merc, Sulph. 

Recurring-Fibroid. — Ars., Lach., Calc, Dulc, Sil. 

Enchondroma. — Sil., Baryta, Calc, Graph., Hep., Led., 

Sep., Sulph. 

Malignant Tumors : Scirrhus. — Bell., Con., Sep., Sil., Carbo 
an., Carbo v., Nux vom., Staph., Sulph. 

Encephaloid. — Acetic acid, Am., Ars., Artem., Carbo an., 

Caust., Chelid., Chin., Kreos., Nux v., Puis., Rhus, Sep., Squilla, 
Tart, em., Zinc. 

Melanosis. — Acet. acid, Arg. nit., Ars., Chelid., Jod., 

Kreos., Lach., Merc, Nit. ac, Petrol., Sil., Squilla. 

Epithelial. — Acet. acid, Arg. nit., Aur., Chelid., Puis., 

Sulph., Thuja. 

Carcinomatous Ulcers. — Apis, Ars., Hep., Sil., Sulph., 

Lach., Merc, Sep. 

Tumors on the Head. — Ars., Calc, Merc, Rhus, Sil., 

Staph, j Chel., Graph., Hep., Petrol., Phos., Sep. 

Eyes. — Bell., Calc, Hep., Sulph. j Am., Ars., Bry., Caust., 

Cham., Con., Kali, Lye, Merc, Nux v., Phos., Puis., Rhus f 
Sep., Sil., Staph., Thuja. 

Nose. — Aur., Caust., Kali c, Merc, Nat. c, Phos. ac, 

Puis., Rhus, Calc. c, Nat. m., Thuja. 

Face. — Bell., Nux v., Ars., Aur., Carbo an., Caust., Chin., 

Con., Hep., Kreos., Merc, Nil. ac, Puis., Rhus, Sep., Sil., 
Staph., Sulph. 

Mouth. — Bell., Merc, Nux v., Phos.j Calc carb., Carbo 

v., Cham., Chin., Lach., Nit. ac. Puis., Sep., Sulph., Zinc. 

Neck. — Calc. carb., Calc. phos., Caust., Merc, Nit. ac, 

Sulph. 

Arms. — Am., Bell., Caust., Puis., Rhus, Sep., Sil., Sulph. 

Chest. — Apis, Am., Bell., Carbo an., Lach., Nit. ac, Nux 

v., Puis., Rhus, Sil., Sulph.- 

Back. — Sil., Am., Ars., Carbo an., Caust., Chin., Con., 



Hep., Nux v., Puis., Rhus, Sulph., Tart em. 



400 Tumors. 

Malignant Tumors : Stomach and Viscera. — Ars., Artem., Hep. 
Sulph., Tart. em. (See Colloid, Scirrhus, and Enceph- 
aloid.) 

Legs. — Ars., Bell., Hep. s., Lack., Nit. ac, Nux v., Puis., 

Rhus, Sep., St'/., Sulph., Zinc ? 

Male Genitals. — Arn., Mere., Nit. ac., Nux v., Puis., 

Sulph., Thuja j Ars., Graph., Kali c, Lye., Phos. ac., Rhus, 
Sep., Staph. 

Tumors on Female Genitals. — Kreos., Nux v., Puis., Sep., 

Sulph., Thuja j Am., Bell., Calc, Carbo an., Carbo v., Cham., 
Chin., Con., Graph., Kali, Lye, Merc, Nit. ac., Rhus, Staph. 

from a Blow. — Arn., Con., Staph. 



Acetic acid. Face pale and waxen; eyes surrounded by a 
dark circle ; cramps and colic in the stomach and abdomen ; ema- 
ciation. Is recommended by J. C. Peters, the apostate, for the 
treatment of warts. It is also the only agent known that will dis- 
solve cancer cells. 

Argentum nit. Discolorations of the skin, from a blue-gray to 
violet, or bronze-colored tinges to the real black ; swelling of the 
mouth, with epithelial cancer. 

Worse in the forenoon, and in the afternoon. Left side. 

Apis mei. Cancerous ulcer ; small ulcers, deep and gray run- 
ning into one another ; burning-itching pain ; pus is light yellow 
and scanty ; erysipelatous inflammation of the surrounding skin ; 
dark purple color of old cancerous scars ; thirst increased, drink- 
ing often, but little at a time. 

Worse in the morning, evening and at night ; also from warmth. 

Better from cold water, and from pressure. (Left side, G.) 

Arnica mon. Cancer following a blow; dull tingling pain in 
an indurated part ; red, blue and yellow spots like ecchymosis ; 
vomiting of coagulated or dark-colored blood ; feeling of repletion 
in the stomach, accompanied by loathing ; pressure, as if a stone 
were lying in the stomach. Pus bloody. 

Worse in the morning, evening, and at night ; also when blow- 
ing the nose, from bodily exertion, when moving, on raising the 
part, and on turning the part. 

Better when letting the limb hang down, and from rubbing. 
Left side. 

Arsenicum alb. Foul, destructive, easily bleeding, cancerous 
ulcers ; black pustules ; burning and corrosive pain in the interior 



Special Therapeutics. 401 

of the affected part, or of the tumor ; the pains are felt at night 
even when sleeping; black blisters, burning and very painful, 
changing to cancerous ulcers; (probably lupoid, G.) burning in 
the ulcer or in the margin, or with a lacerating pain when the 
parts become cold ; spreading ulcers, and suppurating crusts on 
the hairy scalp; cancer of the nose, with ulceration of the nostrils 
high up, and discharge of fetid and bitter-tasting ichor ; cancer of 
the face with bluish lips, or black color about the mouth ; spreading, 
carcinomatous ulcer on the lips ; tumor covered with a hot, and 
bluish-red skin, turning black and sloughing. Pus copious, watery, 
bloody, corroding and fetid. 

Worse in the evening and at night ; also from cold, from exer- 
tion of the body, and in winter. 

Better from warmth. Either side. 

Artemesia VUlg. This remedy has been recommended by 
Noack and Trincks for cancer of the stomach. I have had no 
experience with it, and can find no case cured with it that is unde- 
niably cancer. 

Aurum met. Cancer of the palate, and nasal bones; cancer 
of the nose, and cancerous ulcers. (Lupoid? G.) ; low-spirited. 
Pus greenish, ichorous and putrid. 

Worse in the morning, and at night ; also on getting cold, while 
reposing. 

Better from warmth, while walking, and from moving. Right 
side. 

Baryta carb. Swelling of the sub-maxillary glands, with indu- 
ration ; sensation of soreness of the stomach, while eating it feels 
as if the food had to force itself through some raw places ; sar- 
coma in the neck, with burning. Pus scanty. 

Worse in the night ; also when sitting, and when lying on the 
sore side. 

Better when walking in the open air. Left side. 

Belladonna. Scirrhous indurations; cancerous ulcers, burning 
when touched ; black crust of blood in the bottom of the ulcer. 
Pus scanty. 

Worse in the evening, and at night ; also from cold, on lifting 
the part, on moving, from poultices, from pressure, in the summer, 
on touching the part, and on walking. 

Better when letting the limb hang down, when standing, and 

from warmth. Right side. 
26 



402 Tumors. 

Bryonia alba. Swelling of the nose, with very sore pain when 
touched; nodosities, and indurations on the face; vomiting of 
solids and not of fluids ; burning in the stomach and pit of the 
stomach, especially when moving; sensitiveness of the pit of the 
stomach to touch and pressure ; the ulcers are putrid, and feel 
cold. Pus scanty, yellow, and fetid. 

Worse in the evening, and in the morning ; also from motion, and 
from heat. 

Better when lying on the sound side, on getting warm in bed, 
and when sitting. Right side. 

Calcarea Carb. Tumors and suppurating boils on the head ; 
polypus in the ear, nose, and uterus ; inflamed, swollen, and red 
nose ; pit of the stomach is swollen and painful to pressure ; poly- 
pus in the bladder. Pus copious, putrid and yellowish or whitish. 

Worse in the morning, evening, and the latter part of the night ; 
also in the cold air, and in wet weather. 

Better when the garments are loosened. Right side. 

Calcarea phos. Violent pains in the stomach, with great 
debility, headache and diarrhoea ; the pains are excited by intro- 
ducing the smallest particle of food into the stomach. 

Carbo animalis. Scirrhous cancer on the forehead; sudden 
and short aching from colloid cancer in the pit of the stomach, on 
taking a deep inspiration; clawing and griping in the stomach. 
Dry ulcers. 

Worse in the evening, and at night ; also, in the open, cold, or 
dry air. 

Better from warmth ? Either side. 

Carbo Veg. Pressure and tension around the ulcer; the place 
is hard and painful to the touch ; an ulcer which had been (appar- 
ently) cured, breaks open again, and instead of pus emits a bloody 
lymph : complexion becomes a gray-yellow ; paleness of the face, 
and a drawing pain in the jaws ; vomiting of blood ; cannot bear 
any tight clothing around the waist and abdomen. Pus bloody, 
corroding, or yellow. 

Worse in the morning, and in the forenoon ; also in the open 
air, on getting heated, from pressure, and in the spring and sum- 
mer. 

Better from loosening the clothes. Either side. 

Causticum. The patient cannot bear the pressure of the 
clothes on the stomach ; the lightest food, or even the smallest 



Special Therapeutics. 403 

quantity, causes a violent lancinating pain in the stomach ; scir- 
rhus of the lips, with itching and soreness, which when ulcerated 
has a violent burning pain. Pus bloody, or greenish, and corrod- 
ing ; or thin and watery and yellow. 

Worse in the evening, and at night ; also after eating, from pres- 
sure on the sound side of the limb, or of the body, from rubbing, 
and in clear dry weather. 

Better when lying down, on loosening the garments, on getting 
warm in bed, and in damp wet weather. Right side. 

Chamomilla Vlllg. Swelling, with hardness and blueness of one 
cheek ; vomiting of the food ; oppression of the stomach, as if a 
stone were pressing downwards ; ulcers with darting and lancin- 
ating pain at night, and excessive sensitiveness to the touch. 
Pus corroding and scanty. 

Worse in the evening and at night ; also in the open air, from 
poultices, and from being touched. 

Better when turning the part. Left side. 

Chelidonium majUS. Old, spreading, putrid carcinomatous 
ulcers ; the pain in the stomach is of a gnawing or digging char- 
acter; nausea, with sensation of heat in the stomach; burning 
in the stomach. Pus scanty, corroding and putrid. 

Worse in the morning ; also in the open air, and when walking. 

Better from pressure. Either side. 

China Off. Boring, with painful sensitiveness in the ulcer; 
beating pain in the ulcer, only when moving the part; putrid- 
smelling ulcers, with burning and pressing; black and swollen 
lips ; oppression of the stomach after every meal, with spasmodic 
pains. Pus copious, ichorous, and fetid. 

Worse in the night ; also in the open air, on moving the part, 
and on being touched. 

Better from warmth, and in dry weather. Left side. 

Cinnabaris. Soreness in the stomach, with dizziness and light- 
ness of the head and tightness in the temples. 

Worse in the evening, and at night ; also after sleeping. 

Better in the open air. 

Conium mac. Bleeding of the ulcers, with a secretion of fetid 
ichor; a portion becomes gangrenous; concealed cancer of bone ; 
cancerous swelling and induration of glands ; (secondary deposit) ; 
cancer on the lips; spreading cancerous ulcer on the face; con- 
tractive spasmodic pains in the stomach ; cancers and cancerous 
ulcers after contusion. 



404 Tumors, 

Worse in the morning, and at night ; also in the open air, during 
and after eating, from being uncovered, from pressure, from rub- 
bing, while standing, and on beginning to walk. 

Better when lying down, when moving the part, and from 
warmth. Right side. 

Dulcamara. Warts on the face, and on the hands. 

Worse in the evening ; also when at rest, cold air, and in damp 
weather. 

Better from moving about. Left side. 

Graphites. Smooth, large wens on the hairy scalp, the scalp 
being hot, and itching very much when walking in the open air j 
nausea and vomiting after each meal ; pulsation through the whole 
body whenever he moves. Pus scanty, and smelling like herring- 
brine. 

Worse at night ; also from cold. 

Better from pressure. Either side. 

Hepar sulphur. Corrosive pain in a cancerous ulcer, that 
bleeds at the slightest touch; yellow skin and complexion; erup- 
tions around the mouth, lips and chin, which become converted 
into cancerous ulcers, rapidly spreading; pressure and dull aching 
pain in the stomach, after moderate eating; cancerous ulcer of the 
mamma, with stinging-burning of the edges ; tumors on the head, 
sore to the touch; burning in the stomach. Pus copious or scanty, 
and of almost any character ; smelts like old cheese. 

Worse in the night ; also in the cold air, when lying on the 
painful side, from pressure, and from being touched. 

Better from warmth. Either side. 

Iodine. Complete prostration of strength, and general emacia- 
tion; secondary cancerous deposits; dirty, yellow color of the 
skin ; violent vomiting, renewed by eating ; spasmodic pains in 
the stomach, renewed by eating; pulsations in the pit of the 
stomach. 

Worse in the evening, and at night ; also when lying on the 
painful side, from pressure, from warmth, and when walking 
quickly. 

Better from cold, after eating. Right side. 

Kali carbonicum. Painful tumors on the scalp, like the begin- 
ning of blood-boils, more painful from pressure and motion, and 
less so from external heat, accompanied by itching as if in the 
bones of the head, with great dryness of the hair; nausea as if 
he would faint ; itching warts. 



Special Therapeutics. 405 

Worse in the morning, evening, and at night ; also from cold, 
and when lying on the side. 

Better on getting warm. Either side. 

KreaSOtum. Tightness of the stomach, and of the pit of the 
stomach, the tight clothing is insupportable; painful, hard place 
in the left side of the stomach. Pus corroding, yellow and putrid. 

Worse in the morning ; also in the open air, on moving, and on 
eating cold food. 

Better from warmth. Left side. 

Lachesis. Melanosis, colloid, or encephaloid cancer; small 
ulcers are scattered about, with pain in old cicatrices; violent 
burning; gangrenous spots; cancer of the breast, with lancinating 
pain; the pit of the stomach is very painful to the touch ; inclina- 
tion to lie down, and aversion to move ; ulcers, with great sensi- 
tiveness to the touch; ichorous and offensive discharge, and 
burning when touched, especially around the lower extremities; 
around it are many smaller ulcers, or small pimples, on a purple 
skin; pain in old cicatrices. 

Worse in the evening, or at night ; also in the open air, from 
pressure, and after sleep. 

Better in dry weather. On the right side. 

Ledum pal. Burning as if from red-hot coals in the nose; 
pressure in the stomach after eating a small quantity; painful 
tumors on the joints ; hot, tensive and hard tumors, with tearing 
pains. 

Worse in the evening, and at night; also from heat, on motion, 
and on getting warm in bed. 

Better from cold. Either side. 

Lycopodium. Swelling of the upper lip, with a large ulcer on 
the vermillion border of the lower one; vomiting of food, bile, 
coagulated blood and matter; tension in the hypochondria as if 
from a hoop; great emaciation, and internal debility. 

Worse in the evening, and at night (?) ; also when lying down, 
from poultices, and from the pressure of the clothes. 

Better from cold. Right side. 

Mercurius. Cancerous ulcers, with a severe shooting and lan- 
cinating pain, not relieved by either hot or cold applications ; great 
aggravation of pain from, and sensitiveness to, draughts of air; 
spreading ulcers ; spongy, readily-bleeding and extremely painful 
ulcers; unequal elevations and depressions in the floor of the 



406 Tumors, 

ulcer ; swelling of the whole, or only the tips of the nose, accom- 
panied by pain and inflammation, followed by cancer ; great pain 
in the stomach and pit of the stomach, after a meal and on pres- 
sure ; nausea after a meal. Pus thin, ichorous, and acrid. 

Worse in the evening, and at night ; also from motion, on being 
touched, from heat, and on getting warm in bed. 

Better from cold, from rubbing, and in dry weather. Either 
side. 

Natrum Carb. Red nose, with white pimples on it ; swelling 
of the upper lip ; sensitiveness of the pit of the stomach to the 
touch, and when talking; warts which are painful to the touch. 

Worse in the forenoon ; also from any exertion, before eating, 
and from talking. 

Better after eating, and from pressure. Right side. 

Nitric acid, Pain and swelling of the sub-maxillary gland, 
with induration, ultimately becoming scirrhous ; burning sensa- 
tion in the stomach ; tumors caused by an excessive use of mer- 
cury. Pus bloody and corroding. 

Worse in the evening, and at night ; also when awaking, and 
from touching the part. 

Better (pain in stomach) after eructation. Left side. 

NlIX Vomica. Ulcers, with pale-red, elevated edges ; a painful, 
though small, scirrhous tumor on the forehead ; vomiting of sour- 
smelling mucus, and dark- clotted blood; great inclination to lie 
down, or sit ; aversion to move about, and to the open air. 

Worse in the morning, and at night ; also from motion, and 
being touched. 

Better from strong pressure. Right side. 

Petroleum. Swelling of the nose, with discharge of pus, and 
pain at the root of it; sensation of fullness or swelling of the pit 
of the stomach, with soreness when touched ; pain in the pit of the 
stomach, with sensation as if something were tearing off. 

Worse in the morning, and in the evening ; also when walking 
in the open air. 

Better from warmth. Right side. 

Phosphorus. Swelling and redness of the nose ; polypus, nose 
bleeding readily ; painfulness of the stomach to the touch, and 
when walking. 

Worse in the evening, and at night ; also after eating anything 
warm, when lying on the back, or on the side. 



Special Therapeutics. 407 

Better from rubbing, and after eating something cold. Right 
side 

Phosphoric acid. Discharge of bloody pus from the nose; 
swelling of the dorsum of the nose ; with red spots. 
Worse in the morning, and evening. 

Better from motion, and from pressure. On either side. 

Pulsatilla. Tumors on the scalp, suppurating and affecting 
the skull ; the nose feels sore internally and externally. Pus is 
copious and yellow. 

Worse in the evening, and at night ; also when beginning to 
move, when lying on the left or sound side, in a warm room, and 
from warmth. 

Better in the open air, when moving, walking slowly. Right 
side. 

RhllS tox. Discharge of green, offensive pus from the nose ; 
sensation as if something were torn off in the abdomen; tumors 
which become inflamed, and followed by erysipelas. 

Worse in the morning, and at night ; also during the winter, 
when at rest, on stepping heavily on the ground, when the weather 
changes, in wet weather, and from cold in general. 

Better from motion, and from warmth. Right side. 

Scilla maritima. Pressure in the stomach, as from a stone. 

Worse in the morning, also from motion. Left side. 

Sepia. Tumor on one side of the head above the temple, with 
itching, sensation of tearing and coldness in it, painful on its being 
touched ; nose is swollen and inflamed ; nausea and vomiting 
after eating ; aversion to the open air ; want of natural heat. 

Worse in the forenoon, and in the evening ; also from stretch- 
ing out the affected limb, when at rest, and after eating. 

Better from warm air, and from exercise. Either side. 

Silicea. Painful dryness of the nose ; scirrhus induration 
of the upper lip and face ; continuous nausea and vomiting ; vom- 
iting whenever he drinks ; sensitiveness of the pit of the stomach 
to pressure ; blood-boils and warts on the arms ; the lower limbs 
" go to sleep " easily. Pus thin ; putrid, acrid ichor. 

Worse in the night ; also in the open air, from cold, on getting 
wet, after eating, when lying on the painful side, from pressure, 
and when the weather changes. 

Better from warmth. Right side. 

Staphisagria. Scurfy, and burning painful lips, with pain in 



408 Tumors. 

the sub-maxillary glands, with or without swelling ; cutting pain 
in the abdomen after eating and drinking. 

Worse in the morning, forenoon, in the afternoon, and at night ; 
also when moving, and from pressure. 

Better when lying down in bed, and after lying down. Right 
side. 

Sulphur. Swelling, inflammation ; and dryness of the nose ; 
the region of the stomach becomes very painful to the touch, even 
to the weight of the bed-clothes. 

Worse in the evening, and the night ; also on getting warm in 
bed, when walking quickly, from bodily exertion, when resting, 
when standing, from wet poultices, and on touching the part. 

Better during motion, on getting warm, and in dry weather. 
Left side. 

Tartar emet. Face pale and sunken ; continuous desire to 
vomit ; pulsation in the pit of the stomach. 

Worse in the evening ; also when sitting, and from warmth. 

Better in the open, or cold air. Left side. 

Thuja Occident. Warts on the nose; lips pale and swollen; 
swelling of the pit of the stomach ; emaciation and deadness of 
the affected limbs ; condylomata large and seedy, and frequently 
on a pedicle. 

Worse in the evening, and at night; also in cold and wet 
weather, and from the heat of the bed. 

Better in wet weather, if warm. Left side. 

Zincum met. Pressure at the root of the nose, as if it would 
be pressed into the head ; the nose feels sore internally ; pale 
face ; vomiting of blood, and burning in the stomach. 

Worse in the evening ; also after eating, and in the warm 
room. 

Better in the open air. 

Operations. 

The operations may be summed up in a few words : Of course 
all operations in surgery should be the last resort ; in no other 
class of diseases is this so important as in this. Innocent tumors 
may be perhaps always removed, semi-malignant ones rarely, and 
cancer, with the exception of epithelial, never. The conditions 
calling for a removal of a tumor are — ist, when the growth is 
of large size, and has been present for a long time ; 2nd, when 



Special Therapeutics. 409 

the pressure is causing an absorption of neighboring parts ; 3rd, 
when important vessels, nerves, or canals are being compressed, 
such as the trachea, oesophagus, etc. ; 4th, when your remedies 
do no good, after a reasonable time has elapsed. 

The instruments absolutely necessary are a scalpel and dis- 
secting forceps ; but for fear of accidents, or unlooked-for adhe- 
sions, the following had better be added to the list : Tumor- and 
artery- forceps, metallic retractors, tenaculum and aneurism 
needle. All varieties of encysted tumors which are subcutaneous, 
and all others, whether encysted or not, except those that are in 
one of the large so-called cavities, are removed in the following 
manner : — 

If the tumor is large, make an elliptical incision (0) sufficient to 
take up the superabundant integument, and if possible, eneu- 
cleate the mass with the finger or the handle of the scalpel ; this 
is easily accomplished if the tumor is encysted, or non-adherent. 
Should the opposite of this be the case, the edge of the knife 
must be used very sparingly. When vessels are wounded, and 
the dissection is apt to be a prolonged one, it will be best to 
ligate them as soon as cut ; in general it may be left until the 
last. When the tumor is small, as there will be no loose skin, 
a simple crucial incision (+), or a longitudinal one, will be the 
best. Polypi may be excised, ligated, or twisted off. The two 
last are the best procedures. Other tumors need no special 
mention, excepting ovarian cysts, and these have been spoken of 
in the proper chapter. 

After removing the tumor, wash out the cavity thoroughly 
with Calendula and water (one-third of the drug), and see that 
all hemorrhage is arrested. Leave the wound open until this 
occurs, and then close it with stitches close together, bandage 
quite firmly, and give one or two doses of Rhus. On the second 
day give Staph. 6, in water, about three times a day, and if sup- 
puration threatens, use Calend. in place of it. Should pus form, 
give Hep. sul. 6. 



4IO Effects of Heat and Cold. 



EFFECTS OF HEAT AND COLD. 

BURNS AND SCALDS 

The application of heat may produce either a burn or a scald. 
Of burns we recognize five distinct varieties — simple inflamma- 
tion ; blistering of the skin ; charring of the skin ; charring of 
skin, fascia, and soft parts ; and complete destruction of the whole 
limb or part. 

I?iflammation is of little moment, unless some of the mucous pas- 
sages are involved. Usually the use of Urtica urens, either topi- 
cally or internally, will relieve the pain instantly If the inflam- 
mation, however, should be intense, Aeon, or Bell, may be called 
for. 

In blistering of the skin the treatment is the same. Never open 
the blisters, nor use any oil or grease at any stage of the treat- 
ment. Indeed, this applies with equal force in the case of any of 
the varieties. 

In charring of the skin, we are sure to have a slough, and the 
sooner the better. Aid, then, this process by the use of poultices. 
When the slough is nearly ready to come away, tear it off, and 
dress the ulcer with Calendula. The pain, which at first is quite 
severe, can be very materially abated by the use of Urtica urens 
before applying the poultice, or even adding it to the poultices. 
After the separation of the slough, in addition to using Calend. 
topically, give the same remedy at least as high as the 6th, inter- 
nally. As deformity is liable to occur during the process of cica- 
trization, have the parts lightly bandaged, thoroughly excluded 
from the air, and dressed at very long intervals. 

Charring of the skin, fascia, and muscles usually calls for am- 
putation at once. There is no time for delay or consultation, if 
the main arteries are destroyed, as every moment adds to the 
patient's danger. Waiting for a " line of demarcation " is useless 
if the case is seen within, say, an hour after the accident. Make 
the incision, however, in healthy skin far removed from the limits 
of the accompanying inflammation. ' When the trunk is so injured, 
death will probably ensue ; it will almost certainly follow if opiates 



Effects of Heat and Cold. 41 1 

or anaesthetics are used. The pain can be much relieved, perhaps 
entirely, by the use of the appropriate remedies — Aeon., Bell., 
Canth., or Urtica urens, according to circumstances. 

One prime condition for immediate amputation is, that as charr- 
ing does not permanently close the vessels, the process of slough- 
ing causes a sudden hemorrhage which will likely prove fatal. 
Should this not occur, but the arteries be destroyed and occluded, 
the limb is to be condemned from loss of nutrition. 

Of course, in complete destruction of a limb, there is nothing 
to be done but amputation, if possible. 

Scalds are to be treated in the same manner as burns, as they 
produce the same destruction, minus the charring. 

Treatment. — After all that has been said on this subject, it 
is evident to nearly every one that the first indication is the total 
exclusion of air. How this is to be done is a different matter. 
Cotton batting, complicated bandages, etc., are to be prohibited, 
from the heat they induce. The use of linseed oil, petroleum, 
etc., are equally bad, as greasy substances are not very favorable 
to rapid recovery. We need a light, dry, and air-tight dressing. 
Nothing fulfils this necessity as well as chalk, or flour, or white of 
eggs, mixed to a thin paste. After the first treatment to allay 
pain, apply this dressing, and never remove it until it becomes 
offensive, or the healing process is fairly established. In either 
event, remove a small portion only at a time, and re-apply it before 
removing more. 

Cold. 

The immediate effect of severe cold is commonly known as 
"frost-bite." The part so affected is usually actually frozen, and 
may, if severe, be followed by gangrene. Under the best of cir- 
cumstances unpleasant sequelae remain, such as itching from heat 
{Fragaria vesca, Puis.), bunions {Ant. c, Apis, Ars., Calc, Graph., 
Lye), or chronic inflammations {Agaric, Apis, Ars., Canth., Caps., 
Graph., Lye, Merc, Nat. m., Rhus, Sulph.). 

The immediate effect may be successfully removed by brisk 
friction with snow, or immersion in ice-cold water, with a prefer- 
ence for the former. Avoid warmth, or taking the patient into a 
warm room ; have him carried into a shed or stable, or, if that is 
impracticable, treat him in the open air. When life returns into 
the frozen member, there may be a great deal of burning pain, 
which may be readily controlled with Arsen. or Car bo veg. Should 



412 Effects of Heat and Cold, 

mortification occur, and amputation seem necessary, do not wait 
for a line to form. Recent experience has taught me this : If the 
gangrene is general — i.e., involves the whole part, as a foot or 
hand — it must be amputated. If allowed to detach itself, you 
will have a tender, sensitive stump, almost beyond the reach ot 
cure. If only partial, never amputate, treat with Ars. or Lack., 
and the slough will soon be cast off, and granulations restore the 
part — partially, at least. 

As regards the numerous sequelae spoken of, one of the follow- 
ing remedies will usually much relieve, if not affect a thorough 
cure : — 

AgaricUS m. Pains are diminished and removed by move- 
ments ; pains come on, or are worse, when sitting ; burning, itch- 
ing, and redness of the fingers ; small white pimples are brought 
out by scratching a burning-itching place, and are followed by 
scaling off of the skin ; itching, burning, and redness of the toes, 
followed by desquamation of the cuticle. 

Arsenicum alb. When sitting, or on lying down, the pains 
become intolerable ; amelioration on standing, by moving the part 
and from warmth ; sometimes relief is experienced by firmly com- 
pressing the part ; hands stiff and insensible ; on the tips of the 
fingers burning ulcers ; pains in the feet ; hot, shining and burn- 
ing swelling of the feet ; ulcerating and spreading blisters on the 
feet; (bluish redness of the sides of the feet). Itching burning 
of the chillblains in damp, thawing, spring weather. 

Worse on being touched. 

Better from firm pressure, and from heat of the fire. 

Belladonna. Pains worse at night, and aggravated by the least 
movement ; erysipelatous inflammations and red spots as if from 
flea-bites ; lameness and drawing pain in the elbows and fingers ; 
burning and digging sensation in the soles of the feet ; stinging 
pains in the soles of the feet ; pain as if from a bruise in the 
heel when treading upon it ; very considerable inflammation of a 
bluish-red color, attended with a creeping or tingling sen- 
sation. 

Carbo veg. Drawing in the metacarpal bones ; lacerating in 
the palm of the hands and wrists ; itching, fine eruption on the 
hands ; lacerating in the fingers ; burning in the soles of the feet, 
which are also painful when walking ; swelling and redness of the 
toes ; stitches of the toes ; tips of the toes are ulcerated. Follows 
well after Arsenic. 



Effects of Heat and Cold, 413 

Fragaria Vesca. Pain in the chillblains during the hot season. 
(Lippe). This remedy, when it can be procured, is oftener used 
by applying a befry to the part, retaining it with a light bandage. 
Lachesis. Swelling of the hands, with itching and tingling; 
vesicles, with itching and burning, on the hands and fingers ; 
stinging and also burning in the tips of the fingers ; gangrenous 
ulcers on the fingers ; small itching vesicles on the fingers ; lacer- 
ating in the feet ; swelling of the feet ; small, white, hard, deep 
vesicles, preceded by violent itching ; cracked skin, between and 
on the toes ; inflammation, and suppuration of old chillblains. 

Muriatic acid. A common empirical prescription, often suc- 
cessful, is to bathe the feet every night and morning, in water 
medicated with the acid, about the proportion of ten drops of the 
acid to a pint of water. 

Nitric acid. Itching and swelling of the hands and fingers; 
feet swollen and painful, with fetid sweat; stitch in the heel on 
stepping ; painful sensitiveness of the toes, and of the soles of 
the feet. 

Nat rum mur. Although no connection can readily be seen in 
the symptoms, yet many cases have been cured by me who had 
intense burning and tenderness of the soles of the feet, painful 
when walking, with stinging vesicle on the tip of the tongue and 
sensation as if a hair were lying on the tongue. 

Petroleum. Pain in the wrist-joint as if sprained ; burning of 
the palms of the hands ; rough, chapped finger-tips, with stitches 
and cutting pains ; swelling of the feet, with blisters on the heels 
and between the toes. 

Phosphorus. Tremor and itching of the hands ; the tips of 
the fingers feel numb and insensible ; periodical contraction of 
the fingers like cramps ; paralysis of the fingers. 

Pulsatilla. Inflammation of a livid hue ; itching and beating 
in the part ; painful stiffness in the wrist-joint, or numbness as if 
sprained ; hot swelling of the feet that extends as far as the calves; 
tensive, burning pain, increasing to stitching pain when standing; 
itching and tingling in the toes ; chillblains worse in warm weather, 
and better from cold applications. 

Sulphur. Redness and swelling of the hands and fingers; 
lacerating in the fingers ; creeping and prickling in the ends of 
the fingers; deadness of the fingers in the morning; stiff, red 
finger-joints; cramps in the sole of the foot at every step; ulcer- 
ated vesicles on the soles of the foot ; swelling of the foot. 



INDEX. 



A. 

PAGE 

Abdomen: Contusions of 148 

Emphysema of 149 

Injuries of 148 

Wounds of 149 

Abscess 341 

Chronic ._ 342 

Cold . _ 342 

Diffused 342 

Tympanitic 343 

of Frontal Sinus 75 

of Gums 86 

of Nose 75 

of Perineum 206 

of Prostate 203 

of Tongue 84 

Albuminous Sarcoma 390 

Alveolar Cancer 397 

Amaurosis 60 

Aneurism . 316 

by Anastomosis 318 

Aneurism : Dissecting 317 

Fusiform 316 

Osteo . 292 

Sacculated 317 

Anchylosis 268 

Anthrax _ __ 378 

Antrum : Dropsy of 76 

Suppuration of 76 

Anus: Fistula of 170 

Ulcer and Fissure of 169 

Aphonia 104 

Arteries: Inflammation of . 315 



PAGE 

Arteries : Fatty Degeneration of . . 316 

Calcification of 316 

Arthritis ._ 206 

Asphyxia 100 

of the newly born 100 

from Cold 101 

from Drowning 101 

from Gases 100 

from Lightning 102 

from Strangulation 100 

B. 

Bed sores 375 

Benign Tumors 383 

Bladder: foreign bodies in 149 

Rupture of 149 

Blennorrhagic Epididymitis 235 

Blood : Extravasation of, in Skull 25 

Vessels: Wounds of 301 

Boils. _ 378 

Bones: Caries of 289 

Hydatids of __ 292 

Hypertrophy of 291 

Inflammation of 288 

Necrosis of 290 

Tubercles of 292 

Brain: foreign bodies in 25 

Compression of _. 24 

Concussion of 26 

Hernia of 28 

Inflammation of 27 

Irritation of 27 

Wounds of 28 



416 



Index. 



PAGE 

Breast : Hypertrophy of 125 

Inflammation of 126 

Neuralgia of 125 

Tumors of 127 

Bronchocele 107 

Bubo 183 

Burns .... 410 

Bursas: Enlarged ...... 268 

C. 

Calcification of Arteries 316 

Calculi : Nasal 75 

Renal -- 214 

Uterine . .. 247 

Vesical ... 214 

Cancer . .... 391 

of the Eye 52 

Encephaloid 56 

Melanotic . 57 

Scirrhus . 57 

of the Pharynx .... 103 

of the Tongue 86 

of the Uterus 247 

Colloid 397 

Encephaloid - 394 

Epithelial 397 

Melanosis.. . 396 

Scirrhus. 392 

Cancrum Oris ............. 103 

Carbuncle ........ 378 

Caries . ... 298 

of Spine ... 135 

Cartilaginous tumors . 392 

Cerebral Hernia 28 

Chancre 182 

Cheloid 386 

Chemosis 53 

Chest: Injuries of . 123 

Cholesteatoma 388 

Chronic Abscess . 352 

Cold Abscess . 352 

Effects of 411 

Asphyxia from . 101 

Colloid Cancer 397 

Comminuted fracture of Skull 24 



PAGE 

Compound fracture of Skull 24 

Compression of Brain 24 

of Spinal cord 134 

Concretions in Ear. 40 

in Uterus 246 

Concussion of Brain 2 26 

of Spinal cord _ 134 

Conjunctivitis 52 

Condylomata _. 385 

Contused wound of Scalp 23 

Contusion of Abdomen 488 

of Scalp 22 

Cornea: Opacity of 53 

Coxalgia 268 

Cracks of Tongue 85 

Cranium: fungus of 29 

Curvature of Spine 136 

Cystic Tumors . 384 

D. 

Deafness .. 40 

'Degeneration, fatty, of Arteries. . 316 

Delirium : Nervous 20 

Traumatic 20 

Diffused Abscess 352 

Dislocations 270 

of Spine 133 

Dissecting Aneurism 317 

Dropsy of the Antrum 76 

Scrotum 236 

Drowning : Asphyxia from 101 

Dura-mater: Fungus of .... 29 

E. 

Ear : Foreign bodies in . 41 

Concretions in .... 40 

Inflammation of . 39 

Suppuration of 39 

Tumors of . 40 

Ulcer of 40 

Emphysema Thoracica 124 

Empyema Abdominalis 149 

Thoracica 125 

Encephalitis, traumatic 27 

Encephaloma 394 



Index. 



417 



PAGE 

Encephaloma of the Eye 56 

Enchondroma ._ 391 

Enlarged Bursa? 268 

Entero-Vaginal fistula. __ 249 

Epididymitis: Blennorrhagic 235 

Epistaxis ._ 74 

Epithelial Cancer 397 

Epulis 87 

Esophagus: foreign bodies in 97 

Stricture of _ 105 

Wounds of _- 97 

Esophogatomy 97 

Exostosis . 292 

Eye : Cancer of _ 56 

Foreign bodies in 50 

Wounds of_. 51 

Eyelids: Inflammation of 52 

(Edema of 53 

Wounds of 51 

F. 

Face: Wounds of 37 

Fatty degeneration of Arteries 316 

Tumors 388 

Fibro-plastic Tumors 390 

Cellular tumors 389 

Fibrous Tumors 389 

Recurring _. 390 

in Uterus 247 

Fissures of Anus 169 

of Tongue 85 

Fistula 353 

in Ano 170 

Lachrymalis _. 54 

Salivary 38 

Vaginal 248 

Vaginal entero 249 

Vaginal recto 249 

Vaginal urinary 249 

Fractures 292 

of Skull 24 

of Spine 133 

Fragilitas ossium 291 

Frontal Sinus : Abscess'of 75 

Frost-bite 411 



PAGE 

Fungous Haematodes 394 

Fusiform Aneurism 316 

G. 

Ganglions 268 

Gangrene 372 

of Uterus 247 

Gases: Asphyxia from 100 

Gelatinous Tumors 397 

Glandular Tumors 387 

Glossitis. __ 83 

Glottis: foreign bodies in 99 

Goitre 107 

Gonnorrhcea _ 206 

Gums ; Abscess of , 86 

Ulceration of 87 

H. 

Haematoma 385 

Hematocele 335 

Hemorrhagic Ulcer 302 

Haemorrhoids 169 

Head: Injuries to 23 

Heat: effects of _ 410 

Hernia _. 158 

Cerebri 28 

Humoralis 235 

Hip-disease 268 

Hydatids of Bones. 292 

of Uterus _. 246 

Hydrocele 236 

Hydrometra 245 

Hypertrophy of Bones 291 

of Breast 125 

of Prostate 205 

I. 

Idiopathic Ulcer_ 359 

Incised wound of Scalp 23 

Indolent ulcer 361 

In-growing toe nail 297 

Inflamed ulcer. 360 

Inflammation of Arteries 315 

of Bone 2S8 



4i8 



Index. 



PAGE 

Inflammation of Brain 27 

of Breast __ 126 

of Ear * 39 

of Eye _ 52 

of Eyelids _ _ 52 

of Iris 55 

of Larynx 104 

of Nerves 321 

of Nose 75 

of Prostate 203 

of Spinal cord 135 

of Tongue 83 

of Urethra 206 

of Veins. 299 

Intestinal obstruction 160 

Innocent Tumors 383 

Introduction _ 17 

Irritable ulcers 361 

Irritation of Brain 27 

Iritis r 55 

J- 
Joints : Wounds of 269 

L. 

Laceration of Scalp 23 

of Perineum 150 

of Urethra ._ 150 

Lachrymal fistula __ 54 

Laryngitis 104 

Larynx: foreign bodies in 99 

Concussion of 98 

Paralysis of 99 

Wounds of __ 98. 

Lateral curvature of Spine 136 

Lightning: Asphyxia from 102 

Lipoma 74> 3^8 

Lungs: Injuries to 124 

Lupus 75 

Luxations _. 270 

M. 

Malignant Tumors 391 

Mastitis __ 126 

Melanosis 396 

of the Eye 57 



PAGE 

Moles in the Uterus 246 

Morbus Coxaria _ 268 

Mortification 372 

Mumps __ 106 

Myelitis _. 135 

Myeloid Tumors 390 

N. 

Neck: tumors of 106 

Nervous delirium 20 

Neuralgia 320 

of Breast _ 125 

Neuritis _ 321 

Neuroma 321 

Nevus _ _._ 318 

Non-malignant tumors 383 

Nose : Abscess of. 75 

Bleeding of_ _ 74 

Calculi in _ 75 

Cancer of. __ 75 

Inflammation of _ 75 

Lipoma of _ 74 

Lupus of 75 

Tumors of ; 75 

O. 

Obstruction of Intestines. _ 160 

(Edema of Eyelids 53 

of Glottis. 99 

of Larynx 104 

Onychia 297 

Opacity of Cornea 53 

Ophthalmia 52 

Orchitis 235 

Osteitis 288 

Osteo- Aneurism 292 

Osteo-Sarcoma __ 292 

Otitis 39 

Otorrhoea _ 39 

Ovarian tumors 248 

P. 

Papulse Syphilitica 184 

Paralysis of Larynx 99 

Parotitis ". 106 






Index. 



419 



PAGE 

Parotid: tumors of 106 

Perineum: Abscess of 206 

Laceration of 150 

Periostitis 288 

Phagedena 376 

Phagedaenic Chancre. 183 

Pharynx : Abscess of 102 

Cancer of 103 

Inflammation of 102 

Polypi in 103 

Phlebitis 299 

Physometra 246 

Piles 169 

Pneumo-thorax 124 

Pneumonia-traumatica _ 124 

Polypi 287 

of Ear 40 

of Pharynx 103 

of Nose 75 

of Uterus 247 

Prolapsus : Recti 171 

of Tongue 85 

Prostate : Abscess of 203 

Hypertrophy of 205 

Inflammation of 203 

Tumors of _. 204 

Psoriasis of Tongue. 85 

Pterygium 53 

Pyemia 300 

R. 

Ranula 85 

Recto-Vaginal fistula 249 

Rectum : Prolapsus of 171 

Renal calculi 214 

Retinitis 55 

Rhagades of tongue 85 

Rhinolites 75 

Rickets 291 

Rupture of Bladder 149 

Recurring fibroid tumors 390 

S. 
Sacculated Aneurism 317 



PAGE 

Salivary fistula 38 

Sarcoma 386 

Osteo 292 

Scalds 411 

of Mouth and Pharynx ._ 98 

Scalp: Wounds of 22 

Scirrhus _ 392 

of Breast 127 

of Eye 57 

of Uterus 247 

Scrotum: Dropsy of 236 

Varix of 236 

Semi-malignant tumors 390 

Shock 19 

Simple ulcer 360 

Sinus 353 

Frontal: Abscess of 75 

Skull: Extravasated blood in 25 

Fracture of 24 

Sloughing 361 

Phagedena 376 

Specific ulcers 181-360 

Spina-bifida 137 

Spine; Caries of 135 

Curvature of 136 

Dislocation of 133 

Injuries to 133 

Fracture of 133 

Spinal cord : Compression of 134 

Concussion of 134 

Inflammation of 135 

Stone in Bladder 215 

Strabismus 53 

Strangulation: Asphyxia from 100 

Stricture of Esophagus _ 105 

of Urethra 208 

Stunning 26 

Suppuration, (see abscess) 349 

Synovitis 266 

Syphilis 181 

Congenital 185 

Primary 1S1 

Secondary 183 

Syphilitic Exanthema 184 

Pimples 184 

Tubercle of Tongue 86 



420 



Index, 



T. 

PAGE 

Testicle Swelled 235 

Tetanus _ 322 

Throat: Scalds of 98 

Thyroid : Tumor of 107 

Toe nail : In-growing 297 

Tongue : Abscess of 84 

Cancer of 86 

Fissure of — 85 

Inflammation of 85 

Prolapsus of. 84 

Psoriasis of_. 85 

Syphilitic tubercle of 86 

Tumors of — 85 

Ulcer of 86 

Tonsils: Hypertrophy of 107 

Inflammation of 106 

Trachea: Foreign bodies in 89 

Dislocated cartilages 98 

Wounds of 98 

Tracheotomy- 100 

Traumatic delirium 20 

Encephalitis 27 

Pneumonia 124 

Tubercle of Bone 292 

of Tongue, Syphilitic _ 86 

Tumors ._ 383 

of Breast 127 

of Ear 40 

of Eye _ 50 

of Neck. 106 

of Nose.. 75 

of Ovaries 248 

of Parotid.. 106 

of Pharynx 103 

of Prostate 204 

of Thyroid 107 

of Tongue 85 

Innocent 383 

Atheroma 388 

Cheloid 386 

Cholesteatoma _ 388 

Condylomata 385 

Cystic 384 

Epulis 87 

Fatty 388 



] PAGE 

Tumors: 247, 389 

Fibrous: Fibro cellular 389 

Glandular 387 

Hematoma 385 

Lipoma . 74,388 

Polypi 387 

Ranula 85 

Sarcoma 40, 75, 103, 247, 386 

Sarcoma Osteo 292 

Warts 385 

Semi-malignant 390 

Albuminous Sarcoma 390 

Cartilaginous 391 

Enchondroma 391 

Fibro-plastic 390 

Myeloid ^.„ 391 

Recurring-fibroid 390 

Malignant 57, 127, 247, 391 

Alveolar 397 

Colloid 397 

Encephaloid 56,394 

Epithelial 397 

Fungous Haematodes 394 

Gelatinous 397 

Melanosis 396 

Scirrhus :_. 57,127,392 

Tympanitic Abscess 353 

U. 

Ulcers.. _ 359 

of Anus -. 169 

of Cornea 52 

of Ear 40 

of Gums 87 

of Face 75 

of Nose 75 

of Tongue 86 

of Uterus __ 247 

Idiopathic _ 359 

Indolent 361 

Inflamed . 360 

Irritable- 361 

Hsemorrhagic _ 362 

Phagedenic _ 361 

Simple 360 

Sloughing. 361 



Index. 



421 



PAGE 

Ulcers: Specific 182,360 

Traumatic 359 

Varicose 361 

Weak 360 

Urethra: Inflammation of 206 

Laceration of 150 

Stricture of 208 

Uterus: Diseases of 245 

Calculi of 247 

Cancer of 247 

Concretions in 246 

Fibrous tumors in 247 

Gangrene of 247 

Hydatids of 246 

Hydi-ometra of 245 

Moles in 246 

Physometra of 246 

Polypi of 247 

Ulceration of 247 

V. 

Vagina : foreign bodies in 150 

Vaginal fistula _ 248 

Entero 249 

Rectal 249 

Urinary 249 

Varicose veins 299 



PAGE 

Varicose Ulcer 361 

Varicocele 236 

Vesical calculi 214 

W. 

Warts 385 

Weak ulcer 360 

White swelling 267 

Wounds of Abdomen 149 

of Bladder _ ._ 140 

of Blood-vessels 301 

of Brain _ 28 

of Chest 123 

of Cornea ._ 53 

of Esophagus _. 97 

of Eye 51 

of Eye-lids 51 

of Face 37 

of Iris 55 

of Larynx 98 

of Lungs 24 

of Nerves 322 

of Perineum 150 

of Scalp 22 

of Spinal cord 135 

of Trachea 98 

of Urethra 150 




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